Provider Demographics
NPI:1700100815
Name:MOBLEY, CYNTHIA NEWBY (MA)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:NEWBY
Last Name:MOBLEY
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 1:4129 ROSY MOUND LANE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3259
Mailing Address - Country:US
Mailing Address - Phone:704-391-7135
Mailing Address - Fax:
Practice Address - Street 1:4129 ROSY MOUND LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3259
Practice Address - Country:US
Practice Address - Phone:704-391-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0604103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1356581193Medicaid