Healthcare Provider Details

I. General information

NPI: 1801635768
Provider Name (Legal Business Name): ADVOCACY LAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 W QUANDARY CT
LIVERMORE CO
80536-8743
US

IV. Provider business mailing address

PO BOX 2271
FORT COLLINS CO
80522-2271
US

V. Phone/Fax

Practice location:
  • Phone: 970-232-8887
  • Fax:
Mailing address:
  • Phone: 970-232-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER M DICKSON
Title or Position: CEO
Credential: M.S.W., LCSW
Phone: 970-232-8887