Provider Demographics
NPI:1376892877
Name:NOBLE, MONA DELORES (LAPC)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:DELORES
Last Name:NOBLE
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7839 PROVIDENCE POINT WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5171
Mailing Address - Country:US
Mailing Address - Phone:404-518-8299
Mailing Address - Fax:
Practice Address - Street 1:4151 MEMORIAL DR
Practice Address - Street 2:SUITE 209C
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1504
Practice Address - Country:US
Practice Address - Phone:404-508-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional