Provider Demographics
NPI:1124663638
Name:NOLLE, SHEENA (RBT)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:NOLLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 ROGERS DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-4232
Mailing Address - Country:US
Mailing Address - Phone:843-222-7019
Mailing Address - Fax:
Practice Address - Street 1:817 ROGERS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-4232
Practice Address - Country:US
Practice Address - Phone:843-222-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-19-99915106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician