Provider Demographics
NPI:1700260932
Name:DILLARD-COBB, TONDRA DOROTHEA
Entity Type:Individual
Prefix:MRS
First Name:TONDRA
Middle Name:DOROTHEA
Last Name:DILLARD-COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TONDRA
Other - Middle Name:DOROTHEA
Other - Last Name:DILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 UTAH ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8951
Mailing Address - Country:US
Mailing Address - Phone:910-257-4006
Mailing Address - Fax:910-875-2357
Practice Address - Street 1:135 UTAH ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8951
Practice Address - Country:US
Practice Address - Phone:910-257-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health