Provider Demographics
NPI:1467657197
Name:DOBSON, COSBY DALE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:COSBY
Middle Name:DALE
Last Name:DOBSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3401
Mailing Address - Country:US
Mailing Address - Phone:931-528-2531
Mailing Address - Fax:931-526-7451
Practice Address - Street 1:121 S DIXIE AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3401
Practice Address - Country:US
Practice Address - Phone:931-528-2531
Practice Address - Fax:931-526-7451
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000001821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical