Healthcare Provider Details

I. General information

NPI: 1699147389
Provider Name (Legal Business Name): DANIELA LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 9TH ST
SAN FRANCISCO CA
94103-2603
US

IV. Provider business mailing address

368 FELL ST
SAN FRANCISCO CA
94102-5144
US

V. Phone/Fax

Practice location:
  • Phone: 650-777-0333
  • Fax:
Mailing address:
  • Phone: 415-861-0828
  • Fax: 415-861-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: