Provider Demographics
NPI:1164197117
Name:DEWITT, DARCELLE J (MA, RP)
Entity Type:Individual
Prefix:
First Name:DARCELLE
Middle Name:J
Last Name:DEWITT
Suffix:
Gender:F
Credentials:MA, RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E ABARR DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5436
Mailing Address - Country:US
Mailing Address - Phone:435-817-0155
Mailing Address - Fax:
Practice Address - Street 1:710 HUNTER DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1812
Practice Address - Country:US
Practice Address - Phone:435-817-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional