Provider Demographics
NPI:1114536976
Name:KOBUS, COLLEEN (MS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:KOBUS
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 1:744 DULANEY VALLEY RD STE 17
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5132
Mailing Address - Country:US
Mailing Address - Phone:443-484-8480
Mailing Address - Fax:
Practice Address - Street 1:744 DULANEY VALLEY RD STE 17
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5132
Practice Address - Country:US
Practice Address - Phone:443-484-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional