Provider Demographics
NPI:1215067715
Name:GREEN VALLEY PSYCHOLOGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:GREEN VALLEY PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:NOLET
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-583-8892
Mailing Address - Street 1:2360 W JOPPA RD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4624
Mailing Address - Country:US
Mailing Address - Phone:410-583-8892
Mailing Address - Fax:410-823-5114
Practice Address - Street 1:2360 W JOPPA RD
Practice Address - Street 2:SUITE 219
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4624
Practice Address - Country:US
Practice Address - Phone:410-583-8892
Practice Address - Fax:410-823-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3990103T00000X, 103TC0700X, 103TC2200X, 103TP2701X
103TC0700X
MD7211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty