Individual
LARRY MACON MCCOMMACK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 PATRICK STREET PLZ, CHARLESTON, WV 25387-2444
(304) 233-3200
Mailing address
102 PATRICK STREET PLZ, CHARLESTON, WV 25387-2444
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/09/2022
Last updated
04/09/2022
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