Provider Demographics
NPI:1225706765
Name:DAVIS, NOELLE (BA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 E PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2368
Mailing Address - Country:US
Mailing Address - Phone:804-272-2000
Mailing Address - Fax:804-272-2030
Practice Address - Street 1:412 INVESTORS PL STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1185
Practice Address - Country:US
Practice Address - Phone:804-346-6874
Practice Address - Fax:804-716-7186
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program