Healthcare Provider Details

I. General information

NPI: 1376892877
Provider Name (Legal Business Name): MONA DELORES NOBLE LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 MEMORIAL DR SUITE 209C
DECATUR GA
30032-1504
US

IV. Provider business mailing address

7839 PROVIDENCE POINT WAY
LITHONIA GA
30058-5171
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-0078
  • Fax:
Mailing address:
  • Phone: 404-518-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC002649
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: