Healthcare Provider Details

I. General information

NPI: 1497987705
Provider Name (Legal Business Name): DOLLY NOON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 9TH ST
CRESCENT CITY CA
95531-3432
US

IV. Provider business mailing address

370 9TH ST
CRESCENT CITY CA
95531-3432
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-4349
  • Fax: 707-464-4572
Mailing address:
  • Phone: 707-464-4349
  • Fax: 707-464-4572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: