Individual
CALVIN LIDMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LAC, CCMHC, MAC
Contact information
Practice address
1638 ELWELL ST, BLDG 6236, RM 229, FT CARSON, CO 80913-4356
(719) 526-2196
(719) 526-1983
Mailing address
1650 COCHRANE CIR, BLDG 7505, RM 163, FT CARSON, CO 80913-4604
(719) 526-6073
(719) 526-7732
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACD-167
CO
101YP2500X
Professional Counselor
1098
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11703979
CAQH
CO
Enumeration date
09/17/2006
Last updated
09/03/2013
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