Healthcare Provider Details

I. General information

NPI: 1699288530
Provider Name (Legal Business Name): ROBERT ALLEN WEATHERSB COCHRAN PSY D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 VINEHAVEN DR NE
CONCORD NC
28025-2439
US

IV. Provider business mailing address

1025 VINEHAVEN DR NE
CONCORD NC
28025-2439
US

V. Phone/Fax

Practice location:
  • Phone: 704-918-1343
  • Fax: 704-461-4334
Mailing address:
  • Phone: 704-918-1343
  • Fax: 704-461-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4138
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: