Individual
BETHANY FELISA MIRACLE-LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RESIDENT
Contact information
Practice address
1208 E CHURCHVILLE RD STE 300, BEL AIR, MD 21014-3485
(410) 893-4600
(410) 995-7846
Mailing address
1208 E CHURCHVILLE RD STE 300, BEL AIR, MD 21014-3485
(410) 893-4600
(443) 640-4358
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0704010024
VA
Other
Enumeration date
02/11/2015
Last updated
02/04/2019
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