Provider Demographics
NPI:1780914796
Name:MCCOMMONS, KERRY KATHLEEN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:KATHLEEN
Last Name:MCCOMMONS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:TOMPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:17 KINTYRE CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-2864
Mailing Address - Country:US
Mailing Address - Phone:302-222-0065
Mailing Address - Fax:410-939-8748
Practice Address - Street 1:200 BOOTH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5657
Practice Address - Country:US
Practice Address - Phone:443-350-3260
Practice Address - Fax:410-939-8748
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional