Provider Demographics
NPI:1619182599
Name:KOMOROUS, PATRICIA CUMMINGS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:CUMMINGS
Last Name:KOMOROUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:CUMMINGS-KOMOROUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:64 WELLS LN
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-4582
Mailing Address - Country:US
Mailing Address - Phone:828-859-0280
Mailing Address - Fax:
Practice Address - Street 1:64 WELLS LN
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-4582
Practice Address - Country:US
Practice Address - Phone:828-859-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3731103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling