Provider Demographics
NPI:1528193703
Name:LARSEN, ANNE TERESA (CDP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:TERESA
Last Name:LARSEN
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 S. UNION AVENUE
Mailing Address - Street 2:SUITE C-29
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-879-1200
Mailing Address - Fax:253-879-0103
Practice Address - Street 1:2302 S. UNION AVENUE
Practice Address - Street 2:SUITE C-29
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-879-1200
Practice Address - Fax:253-879-0103
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002776101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)