MEDICARE: LARSEN SUPPORT & WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1275483398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARSEN SUPPORT & WELLNESS LLC

Provider Business Mailing Address
First Line	:	14316 REESE BLVD W STE B-1606
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7959
Country	:	US
Telephone Number	:	828-989-5254
Fax Number	:

Provider Business Practice Location Address
First Line	:	14316 REESE BLVD W STE B-1606
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7959
Country	:	US
Telephone Number	:	828-989-5254
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. SHAQUANNA MECHELLE KILGORE
Credential	:
Telephone Number	:	828-989-5254

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “LARSEN SUPPORT & WELLNESS LLC ” Practice Location

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