Provider Demographics
NPI:1821494873
Name:PAIT, TOMMI ALYSE (MS, LPCA, CRC)
Entity Type:Individual
Prefix:
First Name:TOMMI
Middle Name:ALYSE
Last Name:PAIT
Suffix:
Gender:F
Credentials:MS, LPCA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 OLMSTEAD DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9359
Mailing Address - Country:US
Mailing Address - Phone:336-707-3960
Mailing Address - Fax:
Practice Address - Street 1:3405 WEST WENDOVER AVE
Practice Address - Street 2:SUITE F
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27404
Practice Address - Country:US
Practice Address - Phone:336-323-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00119104101Y00000X
NCA11174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor