Provider Demographics
NPI:1184054934
Name:AGUINIGA, JESSICA MARIE (BS CAC II)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:AGUINIGA
Suffix:
Gender:F
Credentials:BS CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 LIPAN ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4912
Mailing Address - Country:US
Mailing Address - Phone:303-412-3843
Mailing Address - Fax:
Practice Address - Street 1:8801 LIPAN ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-4912
Practice Address - Country:US
Practice Address - Phone:303-412-3843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0007717101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)