Provider Demographics
NPI:1841975463
Name:COMFORT, EVGENIYA (LCMHC-A)
Entity type:Individual
Prefix:
First Name:EVGENIYA
Middle Name:
Last Name:COMFORT
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:JENYA
Other - Middle Name:
Other - Last Name:COMFORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:192 CARTERS FARM DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 AMITY HILL RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-9750
Practice Address - Country:US
Practice Address - Phone:828-291-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health