| NPI | 1467672733 |
|---|---|
| Former Name | LARISSA DAVIS ROARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 259920) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 2010-53) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2024-12-20 |