Provider Demographics
NPI:1275603235
Name:COBB, ANGELA JOYCE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JOYCE
Last Name:COBB
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 W SWAIN RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4171
Mailing Address - Country:US
Mailing Address - Phone:209-518-0287
Mailing Address - Fax:
Practice Address - Street 1:2307 W ALPINE AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-2701
Practice Address - Country:US
Practice Address - Phone:209-942-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist