Provider Demographics
NPI:1023850419
Name:NOEL, ASHNIE
Entity type:Individual
Prefix:
First Name:ASHNIE
Middle Name:
Last Name:NOEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHNIE
Other - Middle Name:
Other - Last Name:NOEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OWNER
Mailing Address - Street 1:7406 S 33RD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5047
Mailing Address - Country:US
Mailing Address - Phone:248-564-8841
Mailing Address - Fax:
Practice Address - Street 1:7406 S 33RD DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5047
Practice Address - Country:US
Practice Address - Phone:248-564-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH9471324500000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility