Provider Demographics
NPI:1003443144
Name:COMMISSO, TORREY DAWN (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:MRS
First Name:TORREY
Middle Name:DAWN
Last Name:COMMISSO
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:TORREY
Other - Middle Name:DAWN
Other - Last Name:DAY-CLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34092 VIOLET LANTERN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:206-669-4288
Mailing Address - Fax:
Practice Address - Street 1:34092 VIOLET LANTERN
Practice Address - Street 2:SUITE 100
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629
Practice Address - Country:US
Practice Address - Phone:206-669-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty