Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ACD.0001010 | CO |
Y | 1041C0700X | Clinical Social Worker | CSW.09925227 | CO |
NPI | 1003392408 |
---|---|
Provider Name | Brittany Edmondson |
First Address | Colorado Springs, CO 80910-4435 |
Second Address | Colorado Springs, CO 80910-4435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2018 |
Last Update Date | 18/07/2018 |