Provider Demographics
NPI:1790015014
Name:COBB, MARTHA J (M A)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:J
Last Name:COBB
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5688
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503
Mailing Address - Country:US
Mailing Address - Phone:252-523-9267
Mailing Address - Fax:
Practice Address - Street 1:834 HARDEE RD
Practice Address - Street 2:SUITE 826C
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-3360
Practice Address - Country:US
Practice Address - Phone:252-523-9267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional