Healthcare Provider Details

I. General information

NPI: 1851078638
Provider Name (Legal Business Name): MEREDITH LARSEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 10/28/2023
Certification Date: 10/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 BRADFORD RD STE 102
VIRGINIA BEACH VA
23455-4094
US

IV. Provider business mailing address

637 NEW JERSEY AVE
NORFOLK VA
23508-2720
US

V. Phone/Fax

Practice location:
  • Phone: 757-453-2144
  • Fax:
Mailing address:
  • Phone: 757-375-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704014133
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704014133
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: