Provider Demographics
NPI:1902490774
Name:MCCOMBS, DOROTHY L
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:MCCOMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6578 KENTUCK RD
Mailing Address - Street 2:
Mailing Address - City:KENNA
Mailing Address - State:WV
Mailing Address - Zip Code:25248-9537
Mailing Address - Country:US
Mailing Address - Phone:304-372-2819
Mailing Address - Fax:
Practice Address - Street 1:6578 KENTUCK RD
Practice Address - Street 2:
Practice Address - City:KENNA
Practice Address - State:WV
Practice Address - Zip Code:25248-9537
Practice Address - Country:US
Practice Address - Phone:304-372-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker