Individual
DIANNE M BACORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LAC
Contact information
Practice address
2255 MIDPOINT DR, FORT COLLINS, CO 80525-4306
(970) 498-7581
Mailing address
2255 MIDPOINT DR, FORT COLLINS, CO 80525-4306
(970) 498-7581
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACD0001092
CO
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
CO
101YP2500X
Professional Counselor
LPC0014693
CO
Other
Enumeration date
02/08/2021
Last updated
02/08/2021
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