Provider Demographics
NPI:1235384348
Name:BRISBANE-NOBLIT, PEGGY LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:LYNN
Last Name:BRISBANE-NOBLIT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2512
Mailing Address - Country:US
Mailing Address - Phone:810-869-0003
Mailing Address - Fax:
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1570
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:810-232-7599
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional