Provider Demographics
NPI:1811353253
Name:MCNULTY, DAWN (CACII)
Entity type:Individual
Prefix:MISS
First Name:DAWN
Middle Name:
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:CACII
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:DENISE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CACII
Mailing Address - Street 1:5250 LEETSDALE DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-629-5293
Mailing Address - Fax:
Practice Address - Street 1:5250 LEETSDALE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1438
Practice Address - Country:US
Practice Address - Phone:303-629-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7894101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)