Provider Demographics
NPI:1609149178
Name:COBBS, DWAYNE CHRISTIAN
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:CHRISTIAN
Last Name:COBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 RENAISSANCE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6170
Mailing Address - Country:US
Mailing Address - Phone:702-483-5401
Mailing Address - Fax:
Practice Address - Street 1:2285 RENAISSANCE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6170
Practice Address - Country:US
Practice Address - Phone:702-483-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst