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1861795668
DWAN NICOLE GOODRICH
PUEBLO, CO
NPI
1861795668
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CO 6530)
Enumeration Date
2010-12-16
Last Update Date
2010-12-16
Business Address
-- DWAN NICOLE GOODRICH BS CAC I
3500 BALTIMORE AVE
PUEBLO, CO 81008-1543
Phone number: 719-545-1181
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Mailing Address
-- DWAN NICOLE GOODRICH BS CAC I
3500 BALTIMORE AVE
PUEBLO, CO 81008-1543
Phone number: 719-545-1181
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