Provider Demographics
NPI:1043512098
Name:COBB, NICHOLE M (LISW-S, OCPC)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:M
Last Name:COBB
Suffix:
Gender:F
Credentials:LISW-S, OCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33333 STATION ST UNIT 391006
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-9533
Mailing Address - Country:US
Mailing Address - Phone:440-252-5354
Mailing Address - Fax:440-252-5379
Practice Address - Street 1:33333 STATION ST UNIT 391006
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-9533
Practice Address - Country:US
Practice Address - Phone:440-252-5354
Practice Address - Fax:440-252-5379
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OHI.0008675-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical