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Individual

MR. LARRY JACKSON LEGG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.A.

Contact information

Practice address
702 PROFESSIONAL PARK DR, STE 106, SUMMERSVILLE, WV 26651-2033
(304) 883-2380
(304) 883-2383
Mailing address
3883 FARMDALE RD, MEADOW BRIDGE, WV 25976-7035
(304) 661-2742
(304) 392-6835

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
630
WV
103TC1900X
Counseling Psychologist
630
WV
103TC2200X
Clinical Child & Adolescent Psychologist
630
WV
103TM1800X
Intellectual & Developmental Disabilities Psychologist
630
WV

Other

Enumeration date
03/05/2007
Last updated
01/27/2017
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