Provider Demographics
NPI:1851740625
Name:AZOULAY, MARC (MA, LPCC, LAC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:AZOULAY
Suffix:
Gender:M
Credentials:MA, LPCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 BROADWAY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3154
Mailing Address - Country:US
Mailing Address - Phone:301-442-9119
Mailing Address - Fax:
Practice Address - Street 1:3050 BROADWAY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3154
Practice Address - Country:US
Practice Address - Phone:301-442-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-12
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000611101YA0400X
COLPCC.0014605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional