Provider Demographics
NPI:1073678660
Name:LAROCHE, FAITH ANTOINETTE (NAACT)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:ANTOINETTE
Last Name:LAROCHE
Suffix:
Gender:F
Credentials:NAACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-2831
Mailing Address - Country:US
Mailing Address - Phone:605-845-7181
Mailing Address - Fax:605-845-5072
Practice Address - Street 1:12451 HIGHWAY 1806
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601
Practice Address - Country:US
Practice Address - Phone:605-845-7181
Practice Address - Fax:605-845-5072
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0007-06CT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)