Provider Demographics
NPI:1679990436
Name:COBB LEWIS, DARA (MDIV)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:COBB LEWIS
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 HATHAWAY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-7671
Mailing Address - Country:US
Mailing Address - Phone:704-615-6622
Mailing Address - Fax:
Practice Address - Street 1:16 OAK GROVE ST UNIT 4
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1655
Practice Address - Country:US
Practice Address - Phone:704-612-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health