Provider Information for 1639612062
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LARRI ROSE MS, NCC, LPC
Sex: Female
NPI: 1639612062
Last Updated: 2016-12-03
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1639612062 | ||||||||
| Enumeration Date | 2016-12-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6468 PAULA CT REX, GA 30273-1636 United States Phone: 770-639-8434 | Fax: | ||||||||
| Primary Practice Address | 6468 PAULA CT REX, GA 30273-1636 United States Phone: 770-639-8434 | Fax: | ||||||||
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