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Individual

LESLIE JOAN ECKENROD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CAC III

Contact information

Practice address
8801 LIPAN ST, THORNTON, CO 80260-4912
(303) 412-3812
(303) 412-3414
Mailing address
8801 LIPAN ST, THORNTON, CO 80260-4912
(303) 412-3812
(303) 412-3414

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6862
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6862
COUNSELOR-ADDICTION
CO
Enumeration date
10/29/2012
Last updated
10/29/2012
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