Provider Demographics
NPI:1639992217
Name:HARRIS, NOELLE R
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35648 HERMITAGE CT
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1047
Mailing Address - Country:US
Mailing Address - Phone:586-482-4389
Mailing Address - Fax:
Practice Address - Street 1:35648 HERMITAGE CT
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-1047
Practice Address - Country:US
Practice Address - Phone:586-482-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903004381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker