Provider Demographics
NPI:1457457459
Name:BRELAND-NOBLE, ALFIEE MATIESE (PHD, MHSC)
Entity Type:Individual
Prefix:DR
First Name:ALFIEE
Middle Name:MATIESE
Last Name:BRELAND-NOBLE
Suffix:
Gender:F
Credentials:PHD, MHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 WISCONSIN AVE NW STE 120
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2265
Mailing Address - Country:US
Mailing Address - Phone:202-687-2392
Mailing Address - Fax:
Practice Address - Street 1:2115 WISCONSIN AVE NW STE 120
Practice Address - Street 2:SUITE 120
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2265
Practice Address - Country:US
Practice Address - Phone:202-687-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3250103TC1900X, 103T00000X
DCPSY1000818103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000967Medicaid
NC2823360Medicare PIN