Provider Demographics
NPI:1770021875
Name:PICONE, COVIN (CAC II)
Entity Type:Individual
Prefix:
First Name:COVIN
Middle Name:
Last Name:PICONE
Suffix:
Gender:M
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17092 E PRENTICE DR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2412
Mailing Address - Country:US
Mailing Address - Phone:303-915-4854
Mailing Address - Fax:
Practice Address - Street 1:17092 E PRENTICE DR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-2412
Practice Address - Country:US
Practice Address - Phone:303-915-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0007220101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)