Individual
LONNIE JAMES LARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO 61378037
Contact information
Practice address
120 SOUTH 3RD STREET, YAKIMA, WA 98901-2875
(509) 248-1800
Mailing address
120 S 3RD ST, YAKIMA, WA 98901-2875
(509) 248-1800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61378037
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2235389
—
WA
05
—
910755984
—
WA
Enumeration date
02/22/2023
Last updated
08/03/2023
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