Provider Demographics
NPI:1386797710
Name:NOBLE, DEVON LANE (LISW)
Entity type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:LANE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:DEVON
Other - Middle Name:LANE
Other - Last Name:TAVANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:700 BROOKSEDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3394
Mailing Address - Country:US
Mailing Address - Phone:614-882-9338
Mailing Address - Fax:814-454-7780
Practice Address - Street 1:700 BROOKSEDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3394
Practice Address - Country:US
Practice Address - Phone:614-882-9338
Practice Address - Fax:614-882-3401
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0009932101YM0800X
PACW0168881041C0700X
OHI.0009932-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health