Provider Demographics
NPI:1548095656
Name:GRANEY-NOELL, DAWN JENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:JENEE
Last Name:GRANEY-NOELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:JENEE
Other - Last Name:GRANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:104 S WHITE ST # 1003
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2773
Mailing Address - Country:US
Mailing Address - Phone:984-977-9399
Mailing Address - Fax:
Practice Address - Street 1:1205 PARTINGTON ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8350
Practice Address - Country:US
Practice Address - Phone:919-349-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2904103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic