Provider Demographics
NPI:1134304868
Name:DELONG, LOIS FM (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:FM
Last Name:DELONG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 S BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-5701
Mailing Address - Country:US
Mailing Address - Phone:505-382-1470
Mailing Address - Fax:
Practice Address - Street 1:4395 SOUTH BANNOCK STREET
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110
Practice Address - Country:US
Practice Address - Phone:505-382-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3812101YA0400X
COLPC.0013102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)