Doctor Name: | MICHELLE LARSON |
NPI Number: | 1295166718 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 601 Kamokila Blvd Ste 355 Kapolei, HI - 967072035 |
Business Phone Number: | 8086927700 |
Business Fax Number: | 8086927712 |
Mailing Address: | 1611 Keeaumoku St Apt 310, HONOLULU |
State: | HI |
Postal Code: | 968224314 |
Phone Number: | 8013729255 |
Fax Number: | |
NPI Enumeration Date: | 12/09/2013 |
NPI Last Update Date: | 12/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |