Most Relevant Information
Provider Data
| NPI Number: | 1003466673 |
| Provider Name: | LARISSA TRAPP |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/16/2019 |
| Last Updated: | 09/16/2019 |
Provider Practice Location
2800 BUSH RIVER RD STE 5
COLUMBIA
SC
292105662
Practice Location Phone/Fax
| Phone: | 8034773093 |
| Fax: |
Provider Mailing Location
1229 WAVERLY PLACE DR
COLUMBIA
SC
292297116
Provider Mailing Phone/Fax
| Phone: | 8034478171 |
| Fax: |