Provider Demographics
NPI:1972073229
Name:PROVIDENCE VIEW COUNSELING & PLAY THERAPY, PLLC
Entity Type:Organization
Organization Name:PROVIDENCE VIEW COUNSELING & PLAY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCA, NCC
Authorized Official - Phone:704-659-6220
Mailing Address - Street 1:5950 FAIRVIEW RD STE 306
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3175
Mailing Address - Country:US
Mailing Address - Phone:704-659-6220
Mailing Address - Fax:
Practice Address - Street 1:5950 FAIRVIEW RD STE 306
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3175
Practice Address - Country:US
Practice Address - Phone:704-659-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty