Provider Demographics
NPI:1962753905
Name:JAN NOLAN LCSW-C CPC LLC
Entity type:Organization
Organization Name:JAN NOLAN LCSW-C CPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-591-9916
Mailing Address - Street 1:222 BOSLEY AVE
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4328
Mailing Address - Country:US
Mailing Address - Phone:410-591-9916
Mailing Address - Fax:410-823-7853
Practice Address - Street 1:222 BOSLEY AVE
Practice Address - Street 2:SUITE A-2
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4328
Practice Address - Country:US
Practice Address - Phone:410-591-9916
Practice Address - Fax:410-823-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty