Provider Demographics
NPI:1245397751
Name:COBB, GARY DON (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DON
Last Name:COBB
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:4001 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2917
Mailing Address - Country:US
Mailing Address - Phone:703-883-4774
Mailing Address - Fax:703-218-1824
Practice Address - Street 1:4001 FAIR RIDGE DR
Practice Address - Street 2:SUITE 305
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2917
Practice Address - Country:US
Practice Address - Phone:703-883-4774
Practice Address - Fax:703-218-1824
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0814001673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical