Provider Demographics
NPI:1467682062
Name:COBB, JENNIFER GALE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GALE
Last Name:COBB
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2104
Mailing Address - Country:US
Mailing Address - Phone:336-337-5469
Mailing Address - Fax:
Practice Address - Street 1:422 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2104
Practice Address - Country:US
Practice Address - Phone:336-337-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0073321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical