Individual
ELISSA MARIE MENDIETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
443 HIGHWAY 105, PALMER LAKE, CO 80133-9003
(719) 955-1800
Mailing address
1610 GATEHOUSE CIR N APT 103, COLORADO SPRINGS, CO 80904-4925
(719) 930-5812
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACD.0002478
CO
Other
Enumeration date
04/30/2024
Last updated
05/13/2024
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