Individual
LARISSA JOELLE BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LASAC
Contact information
Practice address
483 W SEED FARM RD, SACATON, AZ 85147-5000
(602) 528-1200
Mailing address
PO BOX 36, SACATON, AZ 85147-0001
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LASAC-15335
AZ
Other
Enumeration date
03/18/2020
Last updated
03/18/2020
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