Individual
LARRY LIVERMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3865 S MACKINAC TRL, SAULT SAINTE MARIE, MI 49783-9286
(906) 632-2805
(906) 632-1163
Mailing address
125 N LAKE ST, MANISTIQUE, MI 49854-1234
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1-04619
MI
Other
Enumeration date
11/15/2010
Last updated
11/15/2010
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