Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LPCC0015902 | CO |
N | 101YS0200X | School Counselor | LPCC0015902 | CO |
NPI | 1174020291 |
---|---|
Provider Name | Lindsey Autumn Distefano |
First Address | Centennial, CO 80112-3940 |
Second Address | Centennial, CO 80112-3940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2018 |
Last Update Date | 14/05/2020 |