Provider Demographics
NPI:1689381212
Name:CIROME, PORTIA VICTORIA (LPC, CACIII)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:VICTORIA
Last Name:CIROME
Suffix:
Gender:F
Credentials:LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14630 W CORNELL PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4874
Mailing Address - Country:US
Mailing Address - Phone:970-389-6988
Mailing Address - Fax:303-256-9164
Practice Address - Street 1:6870 W 52ND AVE STE 214
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3953
Practice Address - Country:US
Practice Address - Phone:303-898-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional