Provider Demographics
NPI:1891916128
Name:VACCARELLA, CAROLYN ANNE (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANNE
Last Name:VACCARELLA
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:PO BOX 18181
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80402-6036
Mailing Address - Country:US
Mailing Address - Phone:303-994-0673
Mailing Address - Fax:
Practice Address - Street 1:9255 W ALAMEDA AVE
Practice Address - Street 2:UNIT E
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2802
Practice Address - Country:US
Practice Address - Phone:303-994-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional