| NPI | 1629729751 |
|---|---|
| Former Name | LARISSA BOLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2505362) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2304811) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2025-07-23 |