Individual
MISS LARISSA IRKA MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, BCBA, LBA
Contact information
Practice address
2910 EVERGREEN WAY, ELLICOTT CITY, MD 21042-1020
(410) 530-0069
Mailing address
2910 EVERGREEN WAY, ELLICOTT CITY, MD 21042-1020
(410) 530-0069
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA193
MD
Other
Enumeration date
03/09/2016
Last updated
03/09/2016
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