Healthcare Provider Details

I. General information

NPI: 1346315926
Provider Name (Legal Business Name): JONNA J TOBIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311-4E JUDGES ROAD
WILMINGTON NC
28405-3655
US

IV. Provider business mailing address

311-4E JUDGES ROAD
WILMINGTON NC
28405-3655
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-6767
  • Fax:
Mailing address:
  • Phone: 910-791-6767
  • Fax: 910-791-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2755
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: