Healthcare Provider Details

I. General information

NPI: 1053558114
Provider Name (Legal Business Name): TAMMY SARAH COMMONS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMY SARAH AISENBERG

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 EVENING STAR DR
APEX NC
27502-4028
US

IV. Provider business mailing address

128 EVENING STAR DR
APEX NC
27502-4028
US

V. Phone/Fax

Practice location:
  • Phone: 954-699-6805
  • Fax:
Mailing address:
  • Phone: 954-699-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8101
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1253
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2138
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: