Basic Information
| Provider Information | |||||||||
| NPI: | 1992171623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TITCOMB | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | DANIELL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4851 INDEPENDENCE STREET | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325014 | ||||||||
| FaxNumber: | 3034325073 | ||||||||
| Practice Location | |||||||||
| Address1: | 4851 INDEPENDENCE STREET | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325014 | ||||||||
| FaxNumber: | 3034325073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2015 | ||||||||
| LastUpdateDate: | 05/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | CO | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | CSW.09925149 | CO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.