Healthcare Provider Details

I. General information

NPI: 1528976842
Provider Name (Legal Business Name): ANDREA VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E 1ST ST
LA JUNTA CO
81050-1743
US

IV. Provider business mailing address

502 E 1ST ST
LA JUNTA CO
81050-1743
US

V. Phone/Fax

Practice location:
  • Phone: 970-466-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACA.0008103
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: