Provider Demographics
NPI:1780704411
Name:NOBLE, JULISSA B (CAODC-A-CS,LAADC-CA)
Entity type:Individual
Prefix:MRS
First Name:JULISSA
Middle Name:B
Last Name:NOBLE
Suffix:
Gender:F
Credentials:CAODC-A-CS,LAADC-CA
Other - Prefix:MS
Other - First Name:JULISSA
Other - Middle Name:B
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:7169,LCI2840818
Mailing Address - Street 1:2591 OUTLOOK CV
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-1566
Mailing Address - Country:US
Mailing Address - Phone:619-779-9122
Mailing Address - Fax:
Practice Address - Street 1:2055 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3608
Practice Address - Country:US
Practice Address - Phone:805-483-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
MA1612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1780704411Medicaid
CA1780704411Medicaid