Individual
STACY ELDREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
758 MAIN ST, CARBONDALE, CO 81623-1947
(310) 344-4901
Mailing address
758 MAIN ST, CARBONDALE, CO 81623-1947
(310) 344-4901
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACB.0008316
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ACB.0008316
STATE OF COLORADO
CO
Enumeration date
06/25/2018
Last updated
06/25/2018
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