Individual
MS. MARY LARISSA GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LADC
Contact information
Practice address
135 COLORADO ST E, SAINT PAUL, MN 55107-2244
(651) 489-7740
(651) 489-6458
Mailing address
135 COLORADO ST E, SAINT PAUL, MN 55107-2244
(651) 489-7740
(651) 489-6458
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302977
MN
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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