Provider Demographics
NPI:1144763764
Name:NOLAN, COLEEN (MS)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N 56TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8718
Mailing Address - Country:US
Mailing Address - Phone:602-368-4471
Mailing Address - Fax:888-974-1094
Practice Address - Street 1:152 N 56TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8718
Practice Address - Country:US
Practice Address - Phone:602-368-4471
Practice Address - Fax:888-974-1094
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)