Provider Demographics
NPI:1093474454
Name:COBB, AERIAL BRESHAUNA (MS)
Entity Type:Individual
Prefix:
First Name:AERIAL
Middle Name:BRESHAUNA
Last Name:COBB
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 GRANN LLOYD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-1024
Mailing Address - Country:US
Mailing Address - Phone:904-716-2264
Mailing Address - Fax:
Practice Address - Street 1:6639 SOUTHPOINT PKWY STE 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8042
Practice Address - Country:US
Practice Address - Phone:904-438-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)