Provider Demographics
NPI:1679918908
Name:MCTEVIA, JOANNA (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MCTEVIA
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0906
Mailing Address - Country:US
Mailing Address - Phone:720-550-2677
Mailing Address - Fax:
Practice Address - Street 1:12021 PENNSYLVANIA ST
Practice Address - Street 2:SUITE 204
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3150
Practice Address - Country:US
Practice Address - Phone:720-550-2677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
COCSW.099243231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical