Provider Demographics
NPI:1184958829
Name:RZEMIENSKI, LARISSA NADYA (MC, LPC)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:NADYA
Last Name:RZEMIENSKI
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 E. SOUTH FORK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048
Mailing Address - Country:US
Mailing Address - Phone:602-361-0225
Mailing Address - Fax:
Practice Address - Street 1:1444 E SOUTH FORK DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6252
Practice Address - Country:US
Practice Address - Phone:602-361-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC - 11014101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor