Individual
AMBER IVANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LAC
Contact information
Practice address
2525 13TH ST STE 200, BOULDER, CO 80304-4104
(303) 449-6050
(720) 565-4132
Mailing address
1735 S PUBLIC RD STE 203, LAFAYETTE, CO 80026-7093
(303) 665-3036
(303) 665-3397
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD.0000931
CO
1041C0700X
Clinical Social Worker
Primary
CSW.09925143
CO
Other
Enumeration date
03/26/2018
Last updated
05/14/2021
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