Provider Demographics
NPI:1689145344
Name:COBB, JENNIFER (LCMHCA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 SAVANNAH HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3205
Mailing Address - Country:US
Mailing Address - Phone:704-659-6220
Mailing Address - Fax:
Practice Address - Street 1:5950 FAIRVIEW RD STE 306
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3175
Practice Address - Country:US
Practice Address - Phone:704-659-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional