Provider Demographics
NPI:1477223303
Name:KOBBAH, CAROLINE
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:KOBBAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3332
Mailing Address - Country:US
Mailing Address - Phone:313-247-5311
Mailing Address - Fax:
Practice Address - Street 1:3261 GLENDALE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3332
Practice Address - Country:US
Practice Address - Phone:313-247-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851110771104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker