Healthcare Provider Details

I. General information

NPI: 1750846200
Provider Name (Legal Business Name): ANDREANNA NOBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 04/19/2024
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 185
CONCORD CA
94520-4915
US

IV. Provider business mailing address

9620 CHESAPEAKE DR STE 105
SAN DIEGO CA
92123-1324
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-8120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: