Provider Demographics
NPI:1669692745
Name:MALCOMB, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MALCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WEBSTER ROAD
Mailing Address - Street 2:SENECA HEALTH SERVICES INC
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651
Mailing Address - Country:US
Mailing Address - Phone:304-872-6577
Mailing Address - Fax:304-872-5415
Practice Address - Street 1:70 PARCOAL ROAD
Practice Address - Street 2:SENECA HEALTH SERVICES INC
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288
Practice Address - Country:US
Practice Address - Phone:304-847-5425
Practice Address - Fax:304-872-5422
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker