Provider Demographics
NPI:1851603856
Name:DEVENISH, MARIAH (LSW)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:DEVENISH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E VERMIJO AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2172
Mailing Address - Country:US
Mailing Address - Phone:800-661-6323
Mailing Address - Fax:
Practice Address - Street 1:210 E VERMIJO AVE SUITE 20
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:800-661-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO661104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker