| NPI | 1235416538 |
|---|---|
| Former Name | REBEKAH JANE LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 470) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2016-01-04 |