Provider Demographics
NPI:1134881923
Name:TOBIN, JUDITH (MA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:TOBIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 EASTCHESTER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1535
Mailing Address - Country:US
Mailing Address - Phone:336-332-2277
Mailing Address - Fax:336-346-8444
Practice Address - Street 1:2121 EASTCHESTER DR STE 105
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1535
Practice Address - Country:US
Practice Address - Phone:336-332-2277
Practice Address - Fax:336-346-8444
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health