Provider Demographics
NPI:1316409360
Name:NOBLES, BRENT (CDCA)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:NOBLES
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E 191ST ST APT 407
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1339
Mailing Address - Country:US
Mailing Address - Phone:678-908-0056
Mailing Address - Fax:
Practice Address - Street 1:3414 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2618
Practice Address - Country:US
Practice Address - Phone:216-881-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.169978251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health