Individual
LARISSA MANOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
29623 NORTHWESTERN HWY STE 5, SOUTHFIELD, MI 48034-1076
(248) 469-9036
Mailing address
18010 INDIANA ST, DETROIT, MI 48221-2419
(512) 659-2599
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6451022719
MI
Other
Enumeration date
01/11/2023
Last updated
01/11/2023
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