Provider Demographics
NPI:1891827572
Name:COLLARDEY, ELIZABETH KIMJIN (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KIMJIN
Last Name:COLLARDEY
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4244
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-4244
Mailing Address - Country:US
Mailing Address - Phone:303-670-7233
Mailing Address - Fax:
Practice Address - Street 1:26030 HIGHWAY 74
Practice Address - Street 2:KITTREDGE VILLAGE, SUITE G
Practice Address - City:KITTREDGE
Practice Address - State:CO
Practice Address - Zip Code:80417
Practice Address - Country:US
Practice Address - Phone:303-670-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9930541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical