Individual
JACOB ANDREW HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAC II
Contact information
Practice address
11750 LINCOLN ST, NORTHGLENN, CO 80233-1107
(303) 452-9133
(303) 452-9133
Mailing address
11750 LINCOLN ST, NORTHGLENN, CO 80233-1107
(303) 452-9133
(303) 452-9133
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACB 6822
CO
Other
Enumeration date
04/09/2010
Last updated
04/09/2010
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