Individual
CONSTANCE PETTITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LAC
Contact information
Practice address
709 DALE ST STE B, FOUNTAIN, CO 80817-1794
(719) 344-3864
Mailing address
709 DALE ST STE B, FOUNTAIN, CO 80817-1794
(719) 344-3864
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90000158233
—
CO
Enumeration date
02/05/2018
Last updated
01/17/2021
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