Provider Demographics
NPI:1831507748
Name:ROENFELDT, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ROENFELDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4464 S ELATI ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-5652
Mailing Address - Country:US
Mailing Address - Phone:479-236-9598
Mailing Address - Fax:
Practice Address - Street 1:2101 S BLACKHAWK ST STE 240
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1475
Practice Address - Country:US
Practice Address - Phone:720-507-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013967101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health