Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2322 | SC |
NPI | 1003040304 |
---|---|
Provider Name | Dr. Larry Barker |
First Address | Columbia, SC 29209-2005 |
Second Address | Columbia, SC 29209-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 14/05/2009 |