Provider Demographics
NPI:1235711029
Name:NOLEN, RACHEAL JENEE (LGPC)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:JENEE
Last Name:NOLEN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418N TANEY AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4710
Mailing Address - Country:US
Mailing Address - Phone:240-575-8963
Mailing Address - Fax:
Practice Address - Street 1:5026 CAMPBELL BLVD STE H
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5051
Practice Address - Country:US
Practice Address - Phone:410-780-2692
Practice Address - Fax:410-780-2694
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health