Provider Demographics
NPI:1710077326
Name:COCKRELL, CINDY BROWN (LCSW)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:BROWN
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WEST SOUTH MAIN ST
Mailing Address - Street 2:UNIT #5
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-9822
Mailing Address - Country:US
Mailing Address - Phone:252-586-2160
Mailing Address - Fax:252-586-6720
Practice Address - Street 1:127 WEST SOUTH MAIN ST
Practice Address - Street 2:UNIT #5
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-9822
Practice Address - Country:US
Practice Address - Phone:252-586-2160
Practice Address - Fax:252-586-6720
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0013321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106366Medicaid