Provider Demographics
NPI:1780635193
Name:MCCONATHY, LARRY MICHEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MICHEL
Last Name:MCCONATHY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 ALLEN ROAD
Mailing Address - Street 2:APT D
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-378-0400
Mailing Address - Fax:252-847-7551
Practice Address - Street 1:2100 STANTONSBURG ROAD
Practice Address - Street 2:PITT COUNTY MEMORIAL HOSPITAL, PSYCHOLOGY DEPARTMENT
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27835-6028
Practice Address - Country:US
Practice Address - Phone:252-847-4444
Practice Address - Fax:252-847-7551
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR055P103TC1900X, 103TC2200X, 103TC0700X
NC3658103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5Y401Medicare UPIN
AR5Y401Medicare UPIN