| NPI | 1407582265 |
|---|---|
| Former Name | MARCY GARIE LARSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 15680-RAC) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2022-07-25 |