Healthcare Provider Details

I. General information

NPI: 1831844521
Provider Name (Legal Business Name): DONNA L. COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 RAEFORD RD STE C
FAYETTEVILLE NC
28305-5092
US

IV. Provider business mailing address

7917 LESTER DR
FAYETTEVILLE NC
28311-7420
US

V. Phone/Fax

Practice location:
  • Phone: 910-309-6569
  • Fax:
Mailing address:
  • Phone: 808-349-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA16813
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: