Provider Demographics
NPI:1477242667
Name:BOBBETT, ROBIA S (MED)
Entity Type:Individual
Prefix:MS
First Name:ROBIA
Middle Name:S
Last Name:BOBBETT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4322
Mailing Address - Country:US
Mailing Address - Phone:601-342-8215
Mailing Address - Fax:
Practice Address - Street 1:119 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4322
Practice Address - Country:US
Practice Address - Phone:601-342-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS318262101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool