Provider Demographics
NPI:1598284184
Name:COBBSON, CHRISTIE RWAKAYIJA (LLMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:RWAKAYIJA
Last Name:COBBSON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:NATHALIE
Other - Last Name:RWAKAYIJA-RAYMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLMSW
Mailing Address - Street 1:303 SUMMER CIR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7024
Mailing Address - Country:US
Mailing Address - Phone:616-204-5491
Mailing Address - Fax:
Practice Address - Street 1:805 LEONARD ST. NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-451-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801098955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801098955OtherN/A
MI920578776OtherUNITEDHEALTHCARE