Healthcare Provider Details

I. General information

NPI: 1437324456
Provider Name (Legal Business Name): KATHLEEN ALLYSON COMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ALLYSON BRENNAN PH.D.

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 MAPLEWOOD AVE
WINSTON SALEM NC
27103-4009
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2205
  • Fax: 336-802-2206
Mailing address:
  • Phone: 336-716-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3549
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3549
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: