Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003457219 |
---|---|
Provider Name | Sara Correll |
First Address | Colorado Springs, CO 80903-1114 |
Second Address | Colorado Springs, CO 80918-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2019 |
Last Update Date | 22/06/2020 |