Provider Demographics
NPI:1003184730
Name:DIVIESTE-SEVERTSON, LUCIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LUCIA
Middle Name:
Last Name:DIVIESTE-SEVERTSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 MARION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1121
Mailing Address - Country:US
Mailing Address - Phone:720-412-7858
Mailing Address - Fax:
Practice Address - Street 1:1740 MARION ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1121
Practice Address - Country:US
Practice Address - Phone:720-412-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional