Individual
LARRISSA CARLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
31 S MANSFIELD ST, YPSILANTI, MI 48197-4508
(734) 635-6064
Mailing address
31 S MANSFIELD ST, YPSILANTI, MI 48197-4508
(734) 635-6064
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
68815
MI
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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