Individual
KIMBERLY LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC CADAC V
Contact information
Practice address
612 W MORGAN AVE, CHESTERTON, IN 46304-2244
(219) 307-0086
Mailing address
612 W MORGAN AVE, CHESTERTON, IN 46304-2244
(219) 307-0086
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
86000384A
IN
Other
Enumeration date
02/16/2021
Last updated
02/16/2021
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