Provider Demographics
NPI:1881127801
Name:ACOSTA, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 S PARKER RD
Mailing Address - Street 2:#110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2919
Mailing Address - Country:US
Mailing Address - Phone:303-368-8702
Mailing Address - Fax:
Practice Address - Street 1:1602 S PARKER RD
Practice Address - Street 2:#110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2919
Practice Address - Country:US
Practice Address - Phone:303-368-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB0005625101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)