Provider Demographics
NPI:1568590297
Name:DEMISSIE, HELINA (BA, CAC III)
Entity Type:Individual
Prefix:MRS
First Name:HELINA
Middle Name:
Last Name:DEMISSIE
Suffix:
Gender:F
Credentials:BA, CAC III
Other - Prefix:MRS
Other - First Name:HELINA
Other - Middle Name:DEMISSIE
Other - Last Name:GEBREMICHAEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, CAC III
Mailing Address - Street 1:1733 VINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1119
Mailing Address - Country:US
Mailing Address - Phone:303-504-1050
Mailing Address - Fax:303-377-1105
Practice Address - Street 1:1733 VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1119
Practice Address - Country:US
Practice Address - Phone:303-504-1050
Practice Address - Fax:303-377-1105
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6313101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6313OtherCAC III