Provider Demographics
NPI:1235704008
Name:DOBBINS, KOURTNEY (CDCA)
Entity Type:Individual
Prefix:MS
First Name:KOURTNEY
Middle Name:
Last Name:DOBBINS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 MAYFIELD RD APT 207B
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1752
Mailing Address - Country:US
Mailing Address - Phone:216-972-3158
Mailing Address - Fax:
Practice Address - Street 1:3745 MAYFIELD RD APT 207B
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-1752
Practice Address - Country:US
Practice Address - Phone:216-972-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH17500000XMedicaid