Basic Information
| Provider Information | |||||||||
| NPI: | 1518240902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMBS | ||||||||
| FirstName: | CASEY | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 STATE FARM RD | ||||||||
| Address2: | 404 | ||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286074917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287335889 | ||||||||
| FaxNumber: | 8287338743 | ||||||||
| Practice Location | |||||||||
| Address1: | 847 W LAKE DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270302157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367836919 | ||||||||
| FaxNumber: | 8287338743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2011 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1401 | NC | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.