Individual
LARAE DERRICOTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1531 WELLINGTON AVE, INDIANAPOLIS, IN 46219-3844
(317) 414-6294
Mailing address
10141 SANDCHERRY LN, INDIANAPOLIS, IN 46236-6337
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/06/2022
Last updated
06/06/2022
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