Healthcare Provider Details

I. General information

NPI: 1750579728
Provider Name (Legal Business Name): DELISA FAITH WOODMAN M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 FENTON ST
WHEAT RIDGE CO
80214-8118
US

IV. Provider business mailing address

3020 FENTON ST
WHEAT RIDGE CO
80214-8118
US

V. Phone/Fax

Practice location:
  • Phone: 303-467-1544
  • Fax: 303-569-6026
Mailing address:
  • Phone: 303-467-1544
  • Fax: 303-569-6026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1586
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: