Provider Demographics
NPI:1710224548
Name:LARSON, BETHANY ANN (LPC)
Entity type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:ANN
Last Name:LARSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9023 FOREST HILL AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3054
Mailing Address - Country:US
Mailing Address - Phone:571-244-9964
Mailing Address - Fax:
Practice Address - Street 1:9023 FOREST HILL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3054
Practice Address - Country:US
Practice Address - Phone:571-244-9964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health