Individual
JENNIFER REBEKAH LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
8406 SIX FORKS RD STE 101, RALEIGH, NC 27615-3075
(919) 473-6451
(844) 584-4207
Mailing address
8406 SIX FORKS RD STE 101, RALEIGH, NC 27615-3075
(919) 473-6451
(844) 584-4207
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2648
NC
103TC0700X
Clinical Psychologist
2648
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045GA
BCBS
NC
05
—
6000216
—
NC
Enumeration date
08/11/2006
Last updated
10/15/2019
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