Provider Demographics
NPI:1679303598
Name:THEOPHIL, ALICIA CHRISTINE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:CHRISTINE
Last Name:THEOPHIL
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W 70TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5513
Mailing Address - Country:US
Mailing Address - Phone:701-729-1087
Mailing Address - Fax:
Practice Address - Street 1:2801 W 70TH AVE APT 204
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-5513
Practice Address - Country:US
Practice Address - Phone:701-729-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022156101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor