Provider Demographics
NPI:1861531121
Name:DOBYNS, MARY SUSAN (MDIV)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:DOBYNS
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:M
Other - Middle Name:SUSAN
Other - Last Name:DOBYNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDIV
Mailing Address - Street 1:3288 ROBINHOOD ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5464
Mailing Address - Country:US
Mailing Address - Phone:336-774-1999
Mailing Address - Fax:
Practice Address - Street 1:3288 ROBINHOOD ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5464
Practice Address - Country:US
Practice Address - Phone:336-774-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCCFBPPC#11101YP1600X
NCNCLPC#2153101YP2500X
NCNCLMFT#454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29069OtherBLUE CROSS BLUE SHIELD