Provider Demographics
NPI:1497882393
Name:GUENTCHEVA, EVGUENIA (LAC)
Entity Type:Individual
Prefix:
First Name:EVGUENIA
Middle Name:
Last Name:GUENTCHEVA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:
Other - Last Name:GUENTCHEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LAC
Mailing Address - Street 1:503 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2071
Mailing Address - Country:US
Mailing Address - Phone:719-406-8073
Mailing Address - Fax:
Practice Address - Street 1:1012 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3465
Practice Address - Country:US
Practice Address - Phone:719-406-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71101YA0400X
CO4849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)