| NPI | 1609355486 |
|---|---|
| Former Name | CARRIE LYNN LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401016357) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401016357) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2018-08-13 |