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General NPI Number Information
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NPI Number | 1639225931
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Entity Type | Individual
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Provider Name | LISA YOUNG LARANCE M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4925 PACKARD ST
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City | ANN ARBOR
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State | MI
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Zip | 48108-1521
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Country | US
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Telephone | 734-971-9781
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Fax | 734-971-2730
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Provider Business Mailing Address
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Address Line | 5872 CREEKVIEW CT
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City | ANN ARBOR
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State | MI
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Zip | 48108-8531
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Country | US
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Telephone | 973-493-5821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6801088735
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 44SC05239100
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License Number State | NJ
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