Provider Demographics
NPI:1619967015
Name:PERINO, ANGELICA CHAVARRIA (LPC, CAC III)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:CHAVARRIA
Last Name:PERINO
Suffix:
Gender:F
Credentials:LPC, CAC III
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:CHAVARRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CAC III
Mailing Address - Street 1:1001 SHORTLEAF CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4059
Mailing Address - Country:US
Mailing Address - Phone:970-214-2427
Mailing Address - Fax:
Practice Address - Street 1:928 12TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4024
Practice Address - Country:US
Practice Address - Phone:970-336-4936
Practice Address - Fax:970-336-5002
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3752101YP2500X
CO6874101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)