Provider Demographics
NPI:1003016254
Name:BLACK, NOEL LEE (MS, LPC, CHT)
Entity Type:Individual
Prefix:MS
First Name:NOEL
Middle Name:LEE
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS, LPC, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 TOWNE CENTER BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4870
Mailing Address - Country:US
Mailing Address - Phone:601-952-0515
Mailing Address - Fax:601-952-2955
Practice Address - Street 1:357 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4870
Practice Address - Country:US
Practice Address - Phone:601-952-0515
Practice Address - Fax:601-952-2955
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1160101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional