Individual
WILMA LARVIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
28 BLACK COLE, FORT WASHAKIE, WY 82514-0638
(307) 332-4758
(307) 335-8108
Mailing address
PO BOX 638, FORT WASHAKIE, WY 82514-0638
(307) 332-4758
(307) 335-8108
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
WYLAT-174
WY
Other
Enumeration date
05/28/2010
Last updated
05/28/2010
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