Provider Demographics
NPI:1881243301
Name:WINTER, ANASTACIA MONTANA (LPCC0017020)
Entity type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:MONTANA
Last Name:WINTER
Suffix:
Gender:F
Credentials:LPCC0017020
Other - Prefix:
Other - First Name:ANASTACIA
Other - Middle Name:MONTANA
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC0017020
Mailing Address - Street 1:10699 MELODY DR STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4131
Mailing Address - Country:US
Mailing Address - Phone:303-252-4179
Mailing Address - Fax:
Practice Address - Street 1:10699 MELODY DR STE 2
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4131
Practice Address - Country:US
Practice Address - Phone:303-252-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health