Provider Demographics
NPI:1629966429
Name:VILLA, DOLORES PAULINE
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:PAULINE
Last Name:VILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:PAULINE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 N GRANT ST STE R
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1859
Mailing Address - Country:US
Mailing Address - Phone:970-590-2390
Mailing Address - Fax:
Practice Address - Street 1:9303 N COUNTY ROAD 3
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-1712
Practice Address - Country:US
Practice Address - Phone:970-590-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000630101YA0400X
CO0023398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)