Provider Demographics
NPI:1184971756
Name:DUMESNIL, LIVIA DANIELA (MA, LPC, LAC)
Entity type:Individual
Prefix:MS
First Name:LIVIA
Middle Name:DANIELA
Last Name:DUMESNIL
Suffix:
Gender:F
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:LIVIA
Other - Middle Name:DANIELLE
Other - Last Name:DUMESNIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC, LAC
Mailing Address - Street 1:1015 37TH AVENUE CT UNIT 102
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2500
Mailing Address - Country:US
Mailing Address - Phone:970-352-4533
Mailing Address - Fax:970-352-1945
Practice Address - Street 1:1015 37TH AVENUE CT UNIT 102
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2500
Practice Address - Country:US
Practice Address - Phone:970-352-4533
Practice Address - Fax:970-352-1945
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000323101YA0400X
COLPC.0011382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACD.0000323OtherLICENSED ADDICTION COUNSELO
CO39759032Medicaid
COLPC.0011382OtherLICENSED PROFESSIONAL COUNSELOR