Doctor Name: | MRS. DEBORAH DIANE LARSON |
NPI Number: | 1588954812 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC |
License Number: | 301810 |
Business Practice Address: | 645 3rd Ave Sw Pine City, MN - 550631468 |
Business Phone Number: | 3206291362 |
Business Fax Number: | 3206293454 |
Mailing Address: | 645 3rd Ave Sw, PINE CITY |
State: | MN |
Postal Code: | 550631468 |
Phone Number: | 3206291362 |
Fax Number: | 3206293454 |
NPI Enumeration Date: | 04/07/2011 |
NPI Last Update Date: | 04/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 301810 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |