Provider Demographics
NPI:1730638255
Name:CRANDALL, COBY (CPSS)
Entity Type:Individual
Prefix:MR
First Name:COBY
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ASHE AVE
Mailing Address - Street 2:27
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1877
Mailing Address - Country:US
Mailing Address - Phone:919-675-2443
Mailing Address - Fax:
Practice Address - Street 1:211 ASHE AVE
Practice Address - Street 2:27
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1877
Practice Address - Country:US
Practice Address - Phone:919-675-2443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-3282-01175T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist