Healthcare Provider Details

I. General information

NPI: 1053866871
Provider Name (Legal Business Name): NEVELYN NOBLIT TRUMPETER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN NEVELYN NOBLIT TRUMPETER PH.D.

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 BULL ST
COLUMBIA SC
29201-2506
US

IV. Provider business mailing address

1816 BULL ST
COLUMBIA SC
29201-2506
US

V. Phone/Fax

Practice location:
  • Phone: 803-422-0017
  • Fax:
Mailing address:
  • Phone: 803-422-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1408
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: