Individual
MS. AVIVA NAOMI BANNERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2299PEARLST., BOULDER, CO 80302
(970) 673-0846
Mailing address
1166CHERRYVALERD, BOULDER, CO 80303
(201) 407-7634
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0016065
CO
Other
Enumeration date
07/22/2020
Last updated
07/22/2020
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