Provider Demographics
NPI:1235459546
Name:LARSON, NANCY NEAL (LCPC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:NEAL
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2665
Mailing Address - Country:US
Mailing Address - Phone:207-973-2491
Mailing Address - Fax:207-973-2494
Practice Address - Street 1:75 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2665
Practice Address - Country:US
Practice Address - Phone:207-973-2491
Practice Address - Fax:207-973-2494
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health