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General NPI Number Information
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NPI Number | 1669990156
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Entity Type | Individual
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Provider Name | CYNTHIA MAIORINO ORTA CACI
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Gender | Female
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 1824 WOODMOOR DR STE 101
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City | MONUMENT
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State | CO
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Zip | 80132-9097
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Country | US
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Telephone | 719-445-9330
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Fax | 719-445-9330
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Provider Business Mailing Address
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Address Line | 15954 JACKSON CREEK PKWY # B423
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City | MONUMENT
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State | CO
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Zip | 80132-8532
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Country | US
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Telephone | 719-460-3122
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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 | ACA.0007583
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License Number State | CO
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