Basic Information
| Provider Information | |||||||||
| NPI: | 1003016254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | NOEL | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, LPC, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 357 TOWNE CENTER BLVD | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391574870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019520515 | ||||||||
| FaxNumber: | 6019522955 | ||||||||
| Practice Location | |||||||||
| Address1: | 357 TOWNE CENTER BLVD | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391574870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019520515 | ||||||||
| FaxNumber: | 6019522955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1160 | MS | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.