Provider Demographics
NPI:1215359831
Name:LARSEN, AMA
Entity Type:Individual
Prefix:
First Name:AMA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13282 APRIL CIR
Mailing Address - Street 2:
Mailing Address - City:LOVETTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20180-3543
Mailing Address - Country:US
Mailing Address - Phone:517-256-9928
Mailing Address - Fax:517-347-9622
Practice Address - Street 1:13282 APRIL CIR
Practice Address - Street 2:
Practice Address - City:LOVETTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20180-3543
Practice Address - Country:US
Practice Address - Phone:517-256-9928
Practice Address - Fax:517-347-9622
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095504104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker