Individual
MR. LARRY WAYNE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW MA
Contact information
Practice address
70 PARCOAL RD, WEBSTER SPRINGS, WV 26288-9767
(304) 847-5425
(304) 847-5422
Mailing address
81 FRONT ST, RICHWOOD, WV 26261-1307
(304) 847-5425
(304) 847-5422
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
AP00940954
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000479
—
WV
Enumeration date
09/25/2006
Last updated
08/08/2008
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