| NPI | 1982178307 |
|---|---|
| Former Name | CHRISTINA JEAN LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302898) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2019-01-18 |