Individual
AMANDA MARIA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3292 COUNTY ROAD 220, MIDDLEBURG, FL 32068-4357
(904) 291-5561
(904) 291-5575
Mailing address
1726 KINGSLEY AVE STE 2, ORANGE PARK, FL 32073-4411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH17383
FL
Other
Enumeration date
10/02/2019
Last updated
01/06/2020
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