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General NPI Number Information
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NPI Number | 1194049478
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Entity Type | Organization
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Legal Business Name | CHILDRENS VILLAGE OF HOPE
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 5105 PASADENA WAY
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City | BROOMFIELD
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State | CO
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Zip | 80023-4029
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Country | US
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Telephone | 720-887-4036
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 W 120TH AVE #105
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City | WESTMINSTER
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State | CO
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Zip | 80234-2444
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Country | US
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Telephone | 720-887-4036
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | COREY A CANDELARIA
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Credential | M.A., LPC
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Telephone | 720-887-4036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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