Provider Demographics
NPI:1073844676
Name:NOEL, TAMARA AUGUSTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:AUGUSTIN
Last Name:NOEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 HENRY ST
Mailing Address - Street 2:# 5
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3877
Mailing Address - Country:US
Mailing Address - Phone:305-414-4498
Mailing Address - Fax:
Practice Address - Street 1:3405 MIKE PADGETT HWY
Practice Address - Street 2:BUILDING 201
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3815
Practice Address - Country:US
Practice Address - Phone:305-414-4498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0047581041C0700X
NCC0072651041C0700X
GACSW0052281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical