Basic Information
| Provider Information | |||||||||
| NPI: | 1346610235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMER | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ERBEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 FAIRWAY DRIVE | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888809270 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 FAYETTEVILLE ST STE 1100 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276013000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103912089 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 12/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 111114 | NC | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 1-15-19575 | NC | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1346610235 | 05 | NC | MEDICAID |