Provider Demographics
NPI:1669444790
Name:NOONAN, ELIZABETH LYNNE HOWARD (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNNE HOWARD
Last Name:NOONAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:H
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:66 WALNUT ST # 3
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3283
Mailing Address - Country:US
Mailing Address - Phone:828-454-5253
Mailing Address - Fax:828-454-0217
Practice Address - Street 1:66 WALNUT ST # 3
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3283
Practice Address - Country:US
Practice Address - Phone:828-454-5253
Practice Address - Fax:828-454-0217
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2783103T00000X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127CCOtherBLUE CROSS BLUE SHIELD
NC6000272Medicaid
NC6000272Medicaid