Provider Demographics
NPI:1144935354
Name:GANOTSKAYA, ANNA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GANOTSKAYA
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:SAMSONOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:500 KIMBARK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5585
Mailing Address - Country:US
Mailing Address - Phone:303-651-1515
Mailing Address - Fax:720-652-0408
Practice Address - Street 1:500 KIMBARK ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5585
Practice Address - Country:US
Practice Address - Phone:303-651-1515
Practice Address - Fax:720-652-0408
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional