Provider Demographics
NPI:1346528213
Name:SHOWALTER, VICTOR NICHOLAS (MA, CAC-III)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:NICHOLAS
Last Name:SHOWALTER
Suffix:
Gender:M
Credentials:MA, CAC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14211 E 1ST DR
Mailing Address - Street 2:UNIT #11-308
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-3806
Mailing Address - Country:US
Mailing Address - Phone:303-842-2505
Mailing Address - Fax:303-317-6914
Practice Address - Street 1:14211 E 1ST DR
Practice Address - Street 2:UNIT #11-308
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-3806
Practice Address - Country:US
Practice Address - Phone:303-842-2505
Practice Address - Fax:303-317-6914
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6936101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)