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1912329301
DAVID LARSON
MAPLE GROVE, MN
NPI
1912329301
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MN 300922)
Enumeration Date
2014-01-20
Last Update Date
2014-02-11
Business Address
Mr. DAVID LARSON LADC
13603 80TH CIR N
MAPLE GROVE, MN 55369-8961
Phone number: 763-416-1489
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Mailing Address
Mr. DAVID LARSON LADC
1900 SILVER LAKE RD NW SUITE 110
NEW BRIGHTON, MN 55112-1786
Phone number: 651-379-1718
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