Individual
MISS NAOMI NICOLE DORIOTT LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LPC
Contact information
Practice address
12918 63RD AVE N, MAPLE GROVE, MN 55369-6001
(763) 210-9966
Mailing address
12918 63RD AVE N, MAPLE GROVE, MN 55369-6001
(763) 210-9966
(715) 377-0010
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
4609-125
WI
101YP2500X
Professional Counselor
619-226
WI
Other
Enumeration date
07/12/2009
Last updated
05/18/2023
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