Provider Demographics
NPI:1124636923
Name:MAJSTOROVIC, LARISSA (LCMHCA)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:MAJSTOROVIC
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 TRANQUIL OAK PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1475
Mailing Address - Country:US
Mailing Address - Phone:716-341-1715
Mailing Address - Fax:
Practice Address - Street 1:2524 TRANQUIL OAK PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1475
Practice Address - Country:US
Practice Address - Phone:716-341-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health