Provider Demographics
NPI:1114602612
Name:COBLE, CRISTINA VICTORIA
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:VICTORIA
Last Name:COBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 STONE POINT DR UNIT 165
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7082
Mailing Address - Country:US
Mailing Address - Phone:443-370-7215
Mailing Address - Fax:
Practice Address - Street 1:588 BELLERIVE RD STE 1D
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4639
Practice Address - Country:US
Practice Address - Phone:443-949-5322
Practice Address - Fax:443-949-5322
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD260671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical