Provider Demographics
NPI:1033310057
Name:NOLAN, THOMASINE MARIE (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:THOMASINE
Middle Name:MARIE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MS
Other - First Name:TOMMY
Other - Middle Name:
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:2359 FAIRWOOD FOREST CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7366
Mailing Address - Country:US
Mailing Address - Phone:314-346-1269
Mailing Address - Fax:
Practice Address - Street 1:758 CHAMBERLAIN PL
Practice Address - Street 2:SUITE 202
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2716
Practice Address - Country:US
Practice Address - Phone:314-346-1269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001020498101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor