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General NPI Number Information
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NPI Number | 1568161669
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Entity Type | Individual
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Provider Name | ROY COBB III
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Gender | Male
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 30826 LINDER RD
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-8507
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Country | US
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Telephone | 225-665-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 MARTIN LUTHER KING JR AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20032-1542
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Country | US
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Telephone | 202-724-7666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 17778
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License Number State | LA
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