Provider Demographics
NPI:1245772243
Name:FRICKE, DARRELLE LERAAN (MA LPC NCC)
Entity Type:Individual
Prefix:
First Name:DARRELLE
Middle Name:LERAAN
Last Name:FRICKE
Suffix:
Gender:F
Credentials:MA LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 S ELIOT ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-4314
Mailing Address - Country:US
Mailing Address - Phone:303-263-1882
Mailing Address - Fax:
Practice Address - Street 1:4191 S ELIOT ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-4314
Practice Address - Country:US
Practice Address - Phone:303-263-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
14362154OtherCAQH PROVIDER