Provider Demographics
NPI:1154797645
Name:CAROLYN J. NOEL, PLLC
Entity type:Organization
Organization Name:CAROLYN J. NOEL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:703-875-0475
Mailing Address - Street 1:2200 WILSON BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3397
Mailing Address - Country:US
Mailing Address - Phone:703-875-0475
Mailing Address - Fax:
Practice Address - Street 1:2200 WILSON BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3397
Practice Address - Country:US
Practice Address - Phone:703-875-0475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003790103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC492240ZB8MMedicare PIN