Provider Demographics
NPI:1003039736
Name:NOBLE, JERRY W (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:W
Last Name:NOBLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W 1ST ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4225
Mailing Address - Country:US
Mailing Address - Phone:336-748-0809
Mailing Address - Fax:336-748-0809
Practice Address - Street 1:2000 W 1ST ST
Practice Address - Street 2:SUITE 510
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4225
Practice Address - Country:US
Practice Address - Phone:336-748-0809
Practice Address - Fax:336-748-0809
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0968103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical