Individual
ELISE KEYANNA LARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1114 EASTCHESTER DR, HIGH POINT, NC 27265-3114
(336) 802-1007
Mailing address
707 MILTON ST APT 1K, GREENSBORO, NC 27403-3800
(916) 949-8516
(916) 949-8516
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/05/2025
Last updated
06/05/2025
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