Provider Demographics
NPI:1396978664
Name:DOCKINS, CORNELIA JOAN (CACIII)
Entity type:Individual
Prefix:MS
First Name:CORNELIA
Middle Name:JOAN
Last Name:DOCKINS
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 1:5032 FONTANA CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-4278
Mailing Address - Country:US
Mailing Address - Phone:303-484-9350
Mailing Address - Fax:303-484-9350
Practice Address - Street 1:825 IVANHOE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4442
Practice Address - Country:US
Practice Address - Phone:720-339-3050
Practice Address - Fax:303-484-9350
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CO3639101YA0400X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral