Provider Demographics
NPI:1306348321
Name:NOLAN, MAUREEN P (LPC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:P
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LPC
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 716
Mailing Address - Street 2:
Mailing Address - City:PINE LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30072-0716
Mailing Address - Country:US
Mailing Address - Phone:404-713-0488
Mailing Address - Fax:
Practice Address - Street 1:424 PINE DR
Practice Address - Street 2:
Practice Address - City:PINE LAKE
Practice Address - State:GA
Practice Address - Zip Code:30072-3007
Practice Address - Country:US
Practice Address - Phone:404-713-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005412101Y00000X
GAAPC005214101Y00000X
GALPC005412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor