Active NPI
Ruth Komer, LMFTA
- Marriage & Family Therapist
- Davidson, NC
National Provider Identifier
1821686882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 12219A
- Practice address
- 705 Peninsula Dr
Davidson, NC 28036-7200 - Phone
- (704) 237-4042
- NPI assigned
- Jan 5, 2021
- Last updated
- Jan 5, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 12219A | NC | Primary |
Addresses
Primary practice location
705 Peninsula Dr
Davidson, NC 28036-7200
Mailing address
2227 Redwood Dr
Indian Trail, NC 28079-4301
Phone (704) 651-7588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 20, 2024 through Mar 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12219A | NC | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609804800000",
"number": "1821686882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2227 REDWOOD DR",
"city": "INDIAN TRAIL",
"state": "NC",
"postal_code": "280794301",
"telephone_number": "704-651-7588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 PENINSULA DR",
"city": "DAVIDSON",
"state": "NC",
"postal_code": "280367200",
"telephone_number": "704-237-4042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMER",
"first_name": "RUTH",
"credential": "LMFTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-05",
"last_updated": "2021-01-05",
"certification_date": "2021-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "12219A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davidson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.