Provider Demographics
NPI: | 1821370404 |
---|---|
Name: | COMEN, WENDELIN (RETIRED) |
Entity Type: | Individual |
Prefix: | |
First Name: | WENDELIN |
Middle Name: | |
Last Name: | COMEN |
Suffix: | |
Gender: | F |
Credentials: | RETIRED |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 208 TECHNOLOGY PARK LN STE 114 |
Mailing Address - Street 2: | |
Mailing Address - City: | FUQUAY VARINA |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27526-5876 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-522-3412 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 208 TECHNOLOGY PARK LN STE 114 |
Practice Address - Street 2: | |
Practice Address - City: | FUQUAY VARINA |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27526-5876 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-346-3993 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-09-09 |
Last Update Date: | 2022-04-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103TS0200X | ||
NC | 4139 | 101YM0800X, 101YS0200X, 103T00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 103TS0200X, 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
Yes | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |