Individual
ANNETTE MARIE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.C., LADC
Contact information
Practice address
199 COON RAPIDS BLVD NW, SUITE 310, COON RAPIDS, MN 55433-5831
(763) 785-8111
(763) 785-8111
Mailing address
3328 92ND DR NE, BLAINE, MN 55449-6851
(763) 444-1321
(763) 785-8111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303923
MN
101YM0800X
Mental Health Counselor
Primary
01859
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01859
MINNESOTA BOARD OF BEHAVIORAL HEALTH AND THERAPY,LICENSED PROFESSIONAL COUNSELOR
MN
01
—
303923
MINNESOTA BOARD OF BEHAVIORAL HEALTH AND THERAPY, ALCOHOL AND DRUG COUNSELOR
MN
01
—
7078
MINNESOTA CERTIFICATION BOARD, ALCOHOL AND DRUG COUNSELOR-MINNESOTA
MN
Enumeration date
06/05/2016
Last updated
06/05/2016
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