Provider Demographics
NPI:1003507153
Name:KOMETER, ANNA ROSE (MA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:KOMETER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 OLD GRAVES MILL RD APT 18
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5352
Mailing Address - Country:US
Mailing Address - Phone:334-306-8363
Mailing Address - Fax:
Practice Address - Street 1:3712 OLD FOREST RD STE 400
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6959
Practice Address - Country:US
Practice Address - Phone:434-460-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health