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General NPI Number Information
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NPI Number | 1962052258
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Entity Type | Organization
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Legal Business Name | EUDAIMONIA COUNSELING AND RECOVERY SERVICES
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 5555 ERINDALE DR STE 203
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-6965
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Country | US
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Telephone | 719-315-0685
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Fax |
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Provider Business Mailing Address
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Address Line | 436 E SAINT VRAIN ST APT 2
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-6005
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Country | US
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Telephone | 719-322-6108
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MALLORY DIANE HEISE
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Credential | MA, LPC, LAC
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Telephone | 719-322-6108
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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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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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