Individual
KELLY LYNN MCCOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1455 COLFAX RD, FAIRMONT, WV 26554-8159
(304) 290-4941
Mailing address
1455 COLFAX RD, FAIRMONT, WV 26554-8159
(304) 290-4941
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP00940591
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DP00940591
CLINICAL SOCIAL WORKER
WV
Enumeration date
03/30/2022
Last updated
03/30/2022
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