Healthcare Provider Details

I. General information

NPI: 1861531121
Provider Name (Legal Business Name): MARY SUSAN DOBYNS MDIV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M SUSAN DOBYNS MDIV

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 ROBINHOOD ROAD SUITE 106
WINSTON SALEM NC
27106-5464
US

IV. Provider business mailing address

3288 ROBINHOOD ROAD SUITE 106
WINSTON SALEM NC
27106-5464
US

V. Phone/Fax

Practice location:
  • Phone: 336-774-1999
  • Fax:
Mailing address:
  • Phone: 336-774-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberNCCFBPPC#11
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberNCLPC#2153
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberNCLMFT#454
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: