Provider Demographics
NPI:1104317593
Name:DITULLIO, ALICE (CO LPC)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:DITULLIO
Suffix:
Gender:F
Credentials:CO LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 EDISON AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5429
Mailing Address - Country:US
Mailing Address - Phone:720-270-3515
Mailing Address - Fax:
Practice Address - Street 1:4855 EDISON AVE APT 213
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5429
Practice Address - Country:US
Practice Address - Phone:720-270-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional