Individual
MR. LARRY BERT MEDLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 LADY ST, COLUMBIA, SC 29201-3402
(803) 779-1995
Mailing address
1500 LADY ST, COLUMBIA, SC 29201-3402
(803) 779-1995
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4654
SC
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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