Basic Information
| Provider Information | |||||||||
| NPI: | 1316963218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOMB | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | KING | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSWC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 W 40TH ST | ||||||||
| Address2: | STE 427A | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212112120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102352881 | ||||||||
| FaxNumber: | 4102359339 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 W 40TH ST | ||||||||
| Address2: | STE 427A | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212112120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102352881 | ||||||||
| FaxNumber: | 4102359339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4186 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.