Provider Demographics
NPI:1417359662
Name:DANIEL-WINGET, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:DANIEL-WINGET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9123 E MISSISSIPPI AVE APT 15-301
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-6882
Mailing Address - Country:US
Mailing Address - Phone:720-245-0144
Mailing Address - Fax:
Practice Address - Street 1:1571 RACE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1307
Practice Address - Country:US
Practice Address - Phone:720-245-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0132301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health