Basic Information
| Provider Information | |||||||||
| NPI: | 1750715447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EWING | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | ROBERTA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CAC III | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7290 SAMUEL DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802212796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034877776 | ||||||||
| FaxNumber: | 3034877868 | ||||||||
| Practice Location | |||||||||
| Address1: | 7290 SAMUEL DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802212796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034877776 | ||||||||
| FaxNumber: | 3034877868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2013 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 7045 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.