Individual
NASHAWN DEAN RUSSEL LARIVIERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPRC
Contact information
Practice address
50430 SCHOOL HOUSE RD, CANTON, MI 48187-5910
(734) 495-1722
Mailing address
50430 SCHOOL HOUSE RD, CANTON, MI 48187-5910
(734) 495-1722
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
MI
Other
Enumeration date
12/05/2024
Last updated
12/05/2024
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