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General NPI Number Information
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NPI Number | 1326814609
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Entity Type | Individual
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Provider Name | CONSTANTINA CHRISTINA COSTALAS
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Gender | Female
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 7596 W JEWELL AVE # 1-202
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City | LAKEWOOD
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State | CO
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Zip | 80232-6889
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Country | US
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Telephone | 888-902-5943
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Fax |
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Provider Business Mailing Address
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Address Line | 5270 WYANDOT ST
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City | DENVER
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State | CO
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Zip | 80221-1405
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Country | US
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Telephone | 302-276-3735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCC.0021446
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License Number State | CO
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