Provider Demographics
NPI:1912567355
Name:FOBBS, ANTOINETTE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:FOBBS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:FOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:216 ELWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6566
Mailing Address - Country:US
Mailing Address - Phone:301-221-2370
Mailing Address - Fax:
Practice Address - Street 1:216 ELWAY DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-6566
Practice Address - Country:US
Practice Address - Phone:301-221-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104100000X
1041C0700X
MD235221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker