Provider Demographics
NPI:1194713446
Name:NOLLEY, DEBORAH (MS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:NOLLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983-0590
Mailing Address - Country:US
Mailing Address - Phone:304-425-6110
Mailing Address - Fax:304-487-6199
Practice Address - Street 1:2869 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:PETERSTOWN
Practice Address - State:WV
Practice Address - Zip Code:24963-5037
Practice Address - Country:US
Practice Address - Phone:304-425-6110
Practice Address - Fax:304-487-6199
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV641103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721196OtherBCBS
WV0164458001Medicaid