Provider Demographics
NPI:1225774391
Name:MIRANDA, ANTONIA (LPCC)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 ROBBIE VW APT 218
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3263
Mailing Address - Country:US
Mailing Address - Phone:716-983-4158
Mailing Address - Fax:
Practice Address - Street 1:5540 N ACADEMY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3696
Practice Address - Country:US
Practice Address - Phone:719-270-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional