Provider Demographics
NPI:1063788610
Name:DEHERRERA, DENISE (CACIII)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DEHERRERA
Suffix:
Gender:F
Credentials:CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 E. HAMPDEN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4950
Mailing Address - Country:US
Mailing Address - Phone:303-960-6249
Mailing Address - Fax:303-537-6923
Practice Address - Street 1:8801 E. HAMPDEN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4950
Practice Address - Country:US
Practice Address - Phone:303-960-6249
Practice Address - Fax:303-537-6923
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)