Provider Demographics
NPI:1508111451
Name:LAROSE, GINA M (MA, NCC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:LAROSE
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 N TURNBULL DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1748
Mailing Address - Country:US
Mailing Address - Phone:504-450-3862
Mailing Address - Fax:
Practice Address - Street 1:115 KEATING DR
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1629
Practice Address - Country:US
Practice Address - Phone:504-393-5750
Practice Address - Fax:504-393-5760
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist