Provider Demographics
NPI:1023552494
Name:NOLAN, DEVONDRA (LPC)
Entity Type:Individual
Prefix:
First Name:DEVONDRA
Middle Name:
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 1:1650 COUNTY SERVICES PKWY SW STE 2000
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4010
Mailing Address - Country:US
Mailing Address - Phone:770-514-2464
Mailing Address - Fax:770-514-2806
Practice Address - Street 1:1650 COUNTY SERVICES PKWY SW STE 2000
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4010
Practice Address - Country:US
Practice Address - Phone:770-514-2464
Practice Address - Fax:770-514-2806
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005603101YP2500X
GALPC010813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional