Provider Demographics
NPI:1861851016
Name:CASTELLUCCI, MARIE (CACIII, LPC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CASTELLUCCI
Suffix:
Gender:F
Credentials:CACIII, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 SONOMA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3928
Mailing Address - Country:US
Mailing Address - Phone:719-671-1359
Mailing Address - Fax:
Practice Address - Street 1:5128 SONOMA DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3928
Practice Address - Country:US
Practice Address - Phone:719-671-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0006545101YA0400X
COLPP.0001368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)