Individual
LARISSA SHANTAA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
1528 FIVE POINTS RD SW, ALBUQUERQUE, NM 87105-3179
(505) 242-6919
Mailing address
12021 SKYLINE RD NE APT 1603, ALBUQUERQUE, NM 87123-3081
(505) 450-2918
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/21/2018
Last updated
11/21/2018
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