Provider Demographics
NPI:1679245088
Name:NOELL, ALICE ALSTON (DMIN)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:ALSTON
Last Name:NOELL
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ALSTON RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-5632
Mailing Address - Country:US
Mailing Address - Phone:919-649-3872
Mailing Address - Fax:
Practice Address - Street 1:233 ALSTON RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-5632
Practice Address - Country:US
Practice Address - Phone:919-649-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0028151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC002815OtherLCSW LICENSE