Healthcare Provider Details

I. General information

NPI: 1699333203
Provider Name (Legal Business Name): COSBY COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 UNION RD STE B
GASTONIA NC
28054-5581
US

IV. Provider business mailing address

8525 LONG CREEK CLUB DR APT 101
CHARLOTTE NC
28216-2899
US

V. Phone/Fax

Practice location:
  • Phone: 980-522-8061
  • Fax:
Mailing address:
  • Phone: 704-733-7207
  • Fax: 704-749-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DEANNA COSBY
Title or Position: OWNER
Credential: LCMHCS
Phone: 704-953-6259