Provider Demographics
NPI:1659786424
Name:WARD, DEIDRA SUZANNE (LCSW, LAC)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:SUZANNE
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:MS
Other - First Name:DEIDRA
Other - Middle Name:SUZANNE
Other - Last Name:MILLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1777 S HARRISON ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3955
Mailing Address - Country:US
Mailing Address - Phone:303-549-8459
Mailing Address - Fax:
Practice Address - Street 1:1777 S HARRISON ST STE 1200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3955
Practice Address - Country:US
Practice Address - Phone:303-549-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0007665101YA0400X
COCSW.099232941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)