Individual
GEORGE RANKIN MACILWINEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., LPC, CAC I
Contact information
Practice address
2769 IRIS AVE STE 114, BOULDER, CO 80304-4405
(720) 432-3147
Mailing address
2769 IRIS AVE. STE 114, BOULDER, CO 80304-0679
(720) 432-3147
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
13670
CO
101YA0400X
Addiction (Substance Use Disorder) Counselor
6941
CO
101YP2500X
Professional Counselor
Primary
12353
CO
Other
Enumeration date
10/12/2012
Last updated
03/25/2015
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