Provider Demographics
NPI:1831396233
Name:COBBS, GEORGETTE L (AA, BA, MS)
Entity type:Individual
Prefix:MS
First Name:GEORGETTE
Middle Name:L
Last Name:COBBS
Suffix:
Gender:F
Credentials:AA, BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 BERKELEY WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1576
Mailing Address - Country:US
Mailing Address - Phone:510-558-1990
Mailing Address - Fax:510-559-3558
Practice Address - Street 1:1841 BERKELEY WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1576
Practice Address - Country:US
Practice Address - Phone:510-558-1990
Practice Address - Fax:510-559-3558
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF53125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist