Individual
MR. MARK TIMOTHY LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
170 NOTTINGHAM DR, WYTHEVILLE, VA 24382-1412
(276) 698-5595
Mailing address
170 NOTTINGHAM DR, WYTHEVILLE, VA 24382-1412
(276) 698-5595
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701004045
VA
Other
Enumeration date
11/03/2006
Last updated
10/18/2021
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