Provider Demographics
NPI:1265639991
Name:STOBIE, MARK R (PCC, NCC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:STOBIE
Suffix:
Gender:M
Credentials:PCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 DAYTON XENIA RD
Mailing Address - Street 2:STE 900, PMB 108
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6390
Mailing Address - Country:US
Mailing Address - Phone:937-520-8437
Mailing Address - Fax:937-320-9630
Practice Address - Street 1:1407 NEW WAY DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434
Practice Address - Country:US
Practice Address - Phone:937-520-8437
Practice Address - Fax:937-320-9630
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0501350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional