Provider Demographics
NPI:1184061079
Name:BOBB, JONICQUA
Entity type:Individual
Prefix:
First Name:JONICQUA
Middle Name:
Last Name:BOBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JONICQUA
Other - Middle Name:
Other - Last Name:HOOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2630 ALEXANDER FARMS WAY SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2579
Mailing Address - Country:US
Mailing Address - Phone:256-714-3494
Mailing Address - Fax:
Practice Address - Street 1:2630 ALEXANDER FARMS WAY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2579
Practice Address - Country:US
Practice Address - Phone:256-714-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW009682101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor