Provider Demographics
NPI:1043860604
Name:LARSGAARD, DANIELLE LEA (CDC 1, BHA 2)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEA
Last Name:LARSGAARD
Suffix:
Gender:F
Credentials:CDC 1, BHA 2
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LEA
Other - Last Name:REUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1840 BRAGAW ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3463
Mailing Address - Country:US
Mailing Address - Phone:907-562-4155
Mailing Address - Fax:
Practice Address - Street 1:1840 BRAGAW ST STE 110
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3463
Practice Address - Country:US
Practice Address - Phone:907-562-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3915101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor