Healthcare Provider Details

I. General information

NPI: 1447039284
Provider Name (Legal Business Name): REFRESH COUNSELING AND SUPPORT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 MAIN ST STE D
LONGMONT CO
80501-4512
US

IV. Provider business mailing address

1751 HOVER ST # B4-201
LONGMONT CO
80501-7181
US

V. Phone/Fax

Practice location:
  • Phone: 720-534-5983
  • Fax: 720-222-5832
Mailing address:
  • Phone: 720-534-5983
  • Fax: 720-222-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAMOND DOTSON
Title or Position: BILLING AND CREDENTIALING MANAGER
Credential: PHD, LMFT
Phone: 970-576-1717