Provider Demographics
NPI:1164823852
Name:COBBS, LINDA LATRICIA (LPC-IT, SAC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LATRICIA
Last Name:COBBS
Suffix:
Gender:F
Credentials:LPC-IT, SAC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:COBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAC
Mailing Address - Street 1:4906 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2325
Mailing Address - Country:US
Mailing Address - Phone:414-270-4629
Mailing Address - Fax:414-312-6116
Practice Address - Street 1:4906 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2325
Practice Address - Country:US
Practice Address - Phone:414-270-4629
Practice Address - Fax:414-312-6116
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7294101YP2500X
WI15647-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional