| NPI | 1063075638 |
|---|---|
| Former Name | ANDREA LYNN LARSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C7187) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2025-01-03 |