Provider Demographics
NPI:1013229129
Name:LARSON, CRAIG ALAN (LADC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:LARSON
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HORSE POINTE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-1224
Mailing Address - Country:US
Mailing Address - Phone:702-236-4484
Mailing Address - Fax:
Practice Address - Street 1:3900 W CHARLESTON BLVD STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1682
Practice Address - Country:US
Practice Address - Phone:702-453-4673
Practice Address - Fax:702-453-2673
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV232101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)