Healthcare Provider Details

I. General information

NPI: 1013820786
Provider Name (Legal Business Name): NICOLE DOBBINS LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BIRCHFIELD DR
MOUNT LAUREL NJ
08054-4001
US

IV. Provider business mailing address

111 ROUTE 70 E APT 5237
MARLTON NJ
08053-2260
US

V. Phone/Fax

Practice location:
  • Phone: 856-412-8840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00140100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: