Provider Demographics
NPI:1780011080
Name:CHADIMA, CAROLINE M (BS, CAC III)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:M
Last Name:CHADIMA
Suffix:
Gender:F
Credentials:BS, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 LIPAN ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4912
Mailing Address - Country:US
Mailing Address - Phone:303-412-3752
Mailing Address - Fax:303-412-3861
Practice Address - Street 1:55 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5102
Practice Address - Country:US
Practice Address - Phone:303-412-3752
Practice Address - Fax:303-412-3861
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10086101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)