Provider Demographics
NPI:1639828924
Name:LAREMORE, MARY (LMSW, LADAC II)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:LAREMORE
Suffix:
Gender:F
Credentials:LMSW, LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 GRACEY AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4144
Mailing Address - Country:US
Mailing Address - Phone:931-802-9133
Mailing Address - Fax:
Practice Address - Street 1:865 GRACEY AVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4144
Practice Address - Country:US
Practice Address - Phone:931-802-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1516101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)