Provider Demographics
NPI:1952622854
Name:LARSON, KRISTY LOUISE (MS, QP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LOUISE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAPITOLA DR.
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4497
Mailing Address - Country:US
Mailing Address - Phone:919-474-6407
Mailing Address - Fax:
Practice Address - Street 1:100 CAPITOLA DR
Practice Address - Street 2:SUITE 310
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4496
Practice Address - Country:US
Practice Address - Phone:919-474-6407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health