Provider Demographics
NPI:1295201929
Name:WEGMANN, CAROL CHRISTA (LPCC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:CHRISTA
Last Name:WEGMANN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 PINE LN
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9535
Mailing Address - Country:US
Mailing Address - Phone:719-686-6703
Mailing Address - Fax:719-325-8958
Practice Address - Street 1:400 W MIDLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3199
Practice Address - Country:US
Practice Address - Phone:719-686-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0014645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health