Provider Demographics
NPI:1336842350
Name:MOBLEY, IMANI NICOLE
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:NICOLE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WAYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6371
Mailing Address - Country:US
Mailing Address - Phone:919-306-9393
Mailing Address - Fax:
Practice Address - Street 1:314 LAUREL OAKS DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-2099
Practice Address - Country:US
Practice Address - Phone:704-559-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician