Healthcare Provider Details

I. General information

NPI: 1679807291
Provider Name (Legal Business Name): COSBY & COSBY COUNSELING & CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MEDICAL PARK DR STE C
ANDALUSIA AL
36420-5364
US

IV. Provider business mailing address

109 MEDICAL PARK DR
ANDALUSIA AL
36420-5351
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-1818
  • Fax: 334-222-1919
Mailing address:
  • Phone: 334-222-1811
  • Fax: 334-222-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number591
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1384C
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMMA STACY COSBY
Title or Position: OWNER
Credential: LCSW, PIP
Phone: 334-892-3252