MEDICARE: CHARITY GRIMSLEY-HINKLEY LPC, LAC, MAC, SAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0000291	CO
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1538483805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY GRIMSLEY-HINKLEY LPC, LAC, MAC, SAP

Provider Business Mailing Address
First Line	:	4045 WADSWORTH BLVD STE 306
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-4626
Country	:	US
Telephone Number	:	720-295-4852
Fax Number	:

Provider Business Practice Location Address
First Line	:	4045 WADSWORTH BLVD STE 306
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-4626
Country	:	US
Telephone Number	:	720-295-4852
Fax Number	:	720-306-3572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	05/11/2018

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