Provider Demographics
NPI:1467281899
Name:NOLA, KELSEY JORDAN (ALC)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JORDAN
Last Name:NOLA
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ENCLAVE CIR
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-1594
Mailing Address - Country:US
Mailing Address - Phone:205-218-8290
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTHLAND DR STE 225
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35226-3731
Practice Address - Country:US
Practice Address - Phone:205-440-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health