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General NPI Number Information
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NPI Number | 1659226116
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Entity Type | Organization
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Legal Business Name | THE BLACK LOTUS RECOVERY COLLECTIVE
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 26227 E 3RD AVE
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City | AURORA
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State | CO
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Zip | 80018-1768
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Country | US
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Telephone | 303-915-7064
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Fax |
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Provider Business Mailing Address
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Address Line | 26227 E 3RD AVE
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City | AURORA
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State | CO
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Zip | 80018-1768
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EBONY JOHNSON
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Credential | LAC, LSW
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Telephone | 303-915-7064
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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 |
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License Number State |
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