Provider Demographics
NPI:1720067564
Name:NOLAN, HUSAM STEPHEN (LCSW)
Entity type:Individual
Prefix:
First Name:HUSAM
Middle Name:STEPHEN
Last Name:NOLAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9957 SW 54TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4335
Mailing Address - Country:US
Mailing Address - Phone:352-377-2197
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST
Practice Address - Street 2:78 MDG/DGHC
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-8398
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW47131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical