Provider Demographics
NPI:1205339942
Name:MESA, NOELLE CHRISTINA (LMSW)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:CHRISTINA
Last Name:MESA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:CHRISTINA
Other - Last Name:CAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 W 6TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2387
Mailing Address - Country:US
Mailing Address - Phone:208-882-3504
Mailing Address - Fax:877-935-2107
Practice Address - Street 1:317 W 6TH ST STE 208
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2387
Practice Address - Country:US
Practice Address - Phone:208-882-3504
Practice Address - Fax:877-935-2107
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36016104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker