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MR. EDGAR CARL DE VAN CAC II

Addiction (Substance Use Disorder) >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1215139019

Individual Registrant:
MR. EDGAR CARL DE VAN CAC II
Gender: M
Sole Proprietor

Location and contact information for practice:
615 RUSSELL AVE  WALSENBURG, CO 81089-2127 US
Tel: 719-738-2076  Fax: --

Contact information for business:
206 W 3RD ST  WALSENBURG, CO 81089-1904 US
Tel: 719-738-1082  Fax: --

Registration Information:
NPI: 1215139019
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
CO6541

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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