Provider Demographics
NPI:1184681199
Name:DETWEILER, VIRGINIA MARIE (LCSW CAC III)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:MARIE
Last Name:DETWEILER
Suffix:
Gender:F
Credentials:LCSW CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303
Mailing Address - Country:US
Mailing Address - Phone:303-442-0883
Mailing Address - Fax:303-442-7122
Practice Address - Street 1:2300 CANYON BLVD
Practice Address - Street 2:
Practice Address - City:BOUDLER
Practice Address - State:CO
Practice Address - Zip Code:80302
Practice Address - Country:US
Practice Address - Phone:303-442-0883
Practice Address - Fax:303-442-0883
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLCSW991908104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker