Provider Demographics
NPI:1639225683
Name:NOLES, KEITH OLLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:OLLEN
Last Name:NOLES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13009 NC 50N
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592
Mailing Address - Country:US
Mailing Address - Phone:919-341-2810
Mailing Address - Fax:
Practice Address - Street 1:13009 NC 50N
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592
Practice Address - Country:US
Practice Address - Phone:919-341-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0737103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist