Provider Demographics
NPI:1639668528
Name:NOBLE, RAEJEAN (LPCC, LICDC)
Entity Type:Individual
Prefix:
First Name:RAEJEAN
Middle Name:
Last Name:NOBLE
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13837 US HIGHWAY 68 S
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45148-9687
Mailing Address - Country:US
Mailing Address - Phone:937-763-5763
Mailing Address - Fax:
Practice Address - Street 1:149 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-0296
Practice Address - Country:US
Practice Address - Phone:937-712-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2303357101YP2500X
OHLICDC.162125101YA0400X, 101YA0400X
OHC.2103097101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional