Provider Demographics
NPI:1538439120
Name:COMITO, THERESA MARY (MFT)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARY
Last Name:COMITO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 BALTIMORE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2015
Mailing Address - Country:US
Mailing Address - Phone:619-259-4983
Mailing Address - Fax:888-978-2712
Practice Address - Street 1:5480 BALTIMORE DR STE 201
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-259-4983
Practice Address - Fax:888-978-2712
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist