Provider Demographics
NPI:1124716758
Name:LARSEN, KARINA
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:
Other - Last Name:AGOSTINELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3017 W CHARLESTON BLVD STE 70
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1928
Mailing Address - Country:US
Mailing Address - Phone:702-823-3910
Mailing Address - Fax:
Practice Address - Street 1:3017 W CHARLESTON BLVD STE 70
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1928
Practice Address - Country:US
Practice Address - Phone:702-823-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5104101YM0800X, 101YP2500X
NV07080-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)