Individual
GABRIELA LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
329 N GENESEE ST, WAUKEGAN, IL 60085-4205
(847) 623-1730
Mailing address
2728 W VERMONT AVE, WAUKEGAN, IL 60087-3646
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/08/2017
Last updated
09/08/2017
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