Individual
LARISA IVANA CZERNOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2575 NW KLINE ST, ROSEBURG, OR 97471-8827
(541) 673-3504
Mailing address
1455 SE MAIN ST, ROSEBURG, OR 97470-4213
(541) 670-4722
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-22-1577
OR
Other
Enumeration date
04/28/2022
Last updated
04/28/2022
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