Healthcare Provider Details

I. General information

NPI: 1831957075
Provider Name (Legal Business Name): ANTINIQUE M NOBLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3792 BARKWOOD DR
WINSTON SALEM NC
27105-3921
US

IV. Provider business mailing address

3792 BARKWOOD DR
WINSTON SALEM NC
27105-3921
US

V. Phone/Fax

Practice location:
  • Phone: 609-377-3307
  • Fax:
Mailing address:
  • Phone: 609-377-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: ANTINIQUE M NOBLE
Title or Position: CEO
Credential:
Phone: 609-377-3307