Provider Demographics
NPI:1255113668
Name:FRANCA, AGATHA (LCSW)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:FRANCA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2954
Mailing Address - Country:US
Mailing Address - Phone:618-525-1114
Mailing Address - Fax:
Practice Address - Street 1:1324 PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2954
Practice Address - Country:US
Practice Address - Phone:618-525-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099292301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical