Provider Demographics
NPI:1275006843
Name:GAITHER, COMER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COMER
Middle Name:
Last Name:GAITHER
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 1:60 SCHOOL BOARD CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:VA
Mailing Address - Zip Code:22727-3096
Mailing Address - Country:US
Mailing Address - Phone:540-948-5143
Mailing Address - Fax:
Practice Address - Street 1:60 SCHOOL BOARD CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-3096
Practice Address - Country:US
Practice Address - Phone:540-948-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA328941655103TS0200X
VA0813000801103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool