Healthcare Provider Details

I. General information

NPI: 1891916128
Provider Name (Legal Business Name): CAROLYN ANNE VACCARELLA MA. LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 W ALAMEDA AVE UNIT E
LAKEWOOD CO
80226-2802
US

IV. Provider business mailing address

PO BOX 18181
GOLDEN CO
80402-6036
US

V. Phone/Fax

Practice location:
  • Phone: 303-994-0673
  • Fax:
Mailing address:
  • Phone: 303-994-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4255
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: