Provider Demographics
NPI:1497044325
Name:COBB, CAROLYN MCMILLAN (MSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MCMILLAN
Last Name:COBB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KANTON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-7614
Mailing Address - Country:US
Mailing Address - Phone:910-449-5250
Mailing Address - Fax:910-449-6240
Practice Address - Street 1:100 KANTON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-7614
Practice Address - Country:US
Practice Address - Phone:910-346-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0026421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical