Provider Demographics
NPI:1740512003
Name:COSBY, DEANNA (LPCS, LCASA, CCSOTS)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:COSBY
Suffix:
Gender:F
Credentials:LPCS, LCASA, CCSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 LONG CREEK CLUB DR APT 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2899
Mailing Address - Country:US
Mailing Address - Phone:704-953-6259
Mailing Address - Fax:704-749-8742
Practice Address - Street 1:1554 UNION RD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5581
Practice Address - Country:US
Practice Address - Phone:980-522-8061
Practice Address - Fax:704-749-8742
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NCLPC8011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional