Provider Demographics
NPI:1811443971
Name:MASON, LARITA (MA, NCC, LPCMH)
Entity type:Individual
Prefix:
First Name:LARITA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MA, NCC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PASSMORE ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1548
Mailing Address - Country:US
Mailing Address - Phone:302-478-9411
Mailing Address - Fax:
Practice Address - Street 1:99 PASSMORE ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1548
Practice Address - Country:US
Practice Address - Phone:302-518-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional