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Individual

DENA SOUTHERLAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
1143 CAPITOL STREET UNIT 206C, EAGLE, CO 81631
(970) 445-2700
(970) 445-2700
Mailing address
PO BOX 7612, AVON, CO 81620-7612
(970) 445-2700
(970) 445-2700

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
09924204
CO

Other

Enumeration date
01/05/2016
Last updated
01/05/2016
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