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General NPI Number Information
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NPI Number | 1356881106
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Entity Type | Individual
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Provider Name | LESIA WORTHAM
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Gender | Female
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 112 IOWA AVE #4
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5930
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Country | US
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Telephone | 719-358-7338
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Fax | 844-273-2340
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Provider Business Mailing Address
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Address Line | 242 SHADY OAK GRV
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City | COLORADO SPRINGS
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State | CO
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Zip | 80916-1662
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Country | US
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Telephone | 719-306-8677
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACB.0007973
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License Number State | CO
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