Provider Demographics
NPI:1801922182
Name:COLBERT, LARRY WAYNE (CADC-II)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:WAYNE
Last Name:COLBERT
Suffix:
Gender:
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-1051
Mailing Address - Country:US
Mailing Address - Phone:661-861-6111
Mailing Address - Fax:661-861-6161
Practice Address - Street 1:416 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6829
Practice Address - Country:US
Practice Address - Phone:805-849-2318
Practice Address - Fax:805-849-2318
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
CAA04150315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)