Provider Demographics
NPI:1790808590
Name:VINOGRADOVC, ANYTA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ANYTA
Middle Name:
Last Name:VINOGRADOVC
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2472
Mailing Address - Country:US
Mailing Address - Phone:719-339-8547
Mailing Address - Fax:719-391-9142
Practice Address - Street 1:1215 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2472
Practice Address - Country:US
Practice Address - Phone:719-339-8547
Practice Address - Fax:719-391-9142
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health