Healthcare Provider Details

I. General information

NPI: 1982922159
Provider Name (Legal Business Name): CANDELARIA COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 W 120TH AVE 105
WESTMINSTER CO
80234-2444
US

IV. Provider business mailing address

2010 W 120TH AVE 105
WESTMINSTER CO
80234-2444
US

V. Phone/Fax

Practice location:
  • Phone: 303-917-3114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5569
License Number StateCO

VIII. Authorized Official

Name: COREY A CANDELARIA
Title or Position: OWNER
Credential:
Phone: 303-917-3114