Doctor Name: | MS. NEDRA S COMACK |
NPI Number: | 1487705232 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 221b S Lenore Ave Willits, CA - 954903632 |
Business Phone Number: | 7074563861 |
Business Fax Number: | 7074563808 |
Mailing Address: | 221b S Lenore Ave, WILLITS |
State: | CA |
Postal Code: | 954903632 |
Phone Number: | 7074563861 |
Fax Number: | 7074722307 |
NPI Enumeration Date: | 01/16/2007 |
NPI Last Update Date: | 04/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |