Provider Demographics
NPI:1225568470
Name:ALWINE, LARRY (MA, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:ALWINE
Suffix:
Gender:M
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 E FOUNTAIN BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-7715
Mailing Address - Country:US
Mailing Address - Phone:719-415-3510
Mailing Address - Fax:719-938-1914
Practice Address - Street 1:3595 E FOUNTAIN BLVD STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-7715
Practice Address - Country:US
Practice Address - Phone:719-415-3510
Practice Address - Fax:719-938-1914
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000920101YA0400X
CO0014390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty