Provider Demographics
NPI:1982288353
Name:CHICCA, KAITLIN ANNE (LPC, MA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANNE
Last Name:CHICCA
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BOARDWALK DR UNIT 273103
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-4152
Mailing Address - Country:US
Mailing Address - Phone:970-481-2012
Mailing Address - Fax:
Practice Address - Street 1:1703 GLOBE CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6205
Practice Address - Country:US
Practice Address - Phone:970-481-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0018692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional