Provider Demographics
NPI:1215158407
Name:SOURCE COUNSELING AND CONTRACTING LLC
Entity type:Organization
Organization Name:SOURCE COUNSELING AND CONTRACTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VACCARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:303-994-0673
Mailing Address - Street 1:9255 W ALAMEDA AVE
Mailing Address - Street 2:UNIT E
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2802
Mailing Address - Country:US
Mailing Address - Phone:303-994-0673
Mailing Address - Fax:
Practice Address - Street 1:9255 W ALAMEDA AVE
Practice Address - Street 2:UNIT E
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2802
Practice Address - Country:US
Practice Address - Phone:303-994-0673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4255101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty