Provider Demographics
NPI:1649667262
Name:DEMONTIGNY, MARINA S (LPC)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:S
Last Name:DEMONTIGNY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:DEMONTIGNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:100 ARAPAHOE AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5862
Mailing Address - Country:US
Mailing Address - Phone:720-738-1500
Mailing Address - Fax:720-738-3573
Practice Address - Street 1:100 ARAPAHOE AVE STE 12
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5862
Practice Address - Country:US
Practice Address - Phone:720-738-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional