Provider Demographics
NPI:1730955220
Name:COBB, DEJIAH DIVINE
Entity type:Individual
Prefix:
First Name:DEJIAH
Middle Name:DIVINE
Last Name:COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 UNIVERSITY WAY UNIT 572A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1146
Mailing Address - Country:US
Mailing Address - Phone:661-916-7396
Mailing Address - Fax:
Practice Address - Street 1:661 UNIVERSITY WAY UNIT 572A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1146
Practice Address - Country:US
Practice Address - Phone:661-916-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor