Provider Demographics
NPI:1992090005
Name:NOLAN, THOMAS Q (MA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:Q
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 CAROL LN
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4756
Mailing Address - Country:US
Mailing Address - Phone:925-405-7243
Mailing Address - Fax:925-283-6779
Practice Address - Street 1:1080 CAROL LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4756
Practice Address - Country:US
Practice Address - Phone:925-405-7243
Practice Address - Fax:925-283-6779
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist