Provider Demographics
NPI:1558459503
Name:SOMME, CHARRISSE TREMAINE
Entity Type:Individual
Prefix:MS
First Name:CHARRISSE
Middle Name:TREMAINE
Last Name:SOMME
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHARRISSE
Other - Middle Name:TREMAINE
Other - Last Name:SOMME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2600 DEVIN KATHLEEN LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6798
Mailing Address - Country:US
Mailing Address - Phone:336-760-0700
Mailing Address - Fax:336-771-3025
Practice Address - Street 1:2600 DEVIN KATHLEEN LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6798
Practice Address - Country:US
Practice Address - Phone:336-760-0700
Practice Address - Fax:336-771-3025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102841Medicaid