Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1707-01 | CO |
NPI | 1003242611 |
---|---|
Provider Name | Kimberly Anne Sutherland |
First Address | Denver, CO 80209-2721 |
Second Address | Denver, CO 80210-4014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 16/09/2013 |