Provider Demographics
NPI:1962557322
Name:DIDOMENCIO, NATALIE MARIE I (MA-LPC)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:MARIE
Last Name:DIDOMENCIO
Suffix:I
Gender:F
Credentials:MA-LPC
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:HART
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4851 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5071
Practice Address - Street 1:12055 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1506
Practice Address - Country:US
Practice Address - Phone:303-432-5400
Practice Address - Fax:303-432-5442
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3458101YM0800X
COACC.0997756101YA0400X
COLPC.0003458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)