Provider Demographics
NPI:1376879833
Name:NOLEN, FREDDIE (LPC)
Entity Type:Individual
Prefix:
First Name:FREDDIE
Middle Name:
Last Name:NOLEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PARK ST NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4602
Mailing Address - Country:US
Mailing Address - Phone:703-281-4928
Mailing Address - Fax:703-242-1454
Practice Address - Street 1:133 PARK ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4602
Practice Address - Country:US
Practice Address - Phone:703-281-4928
Practice Address - Fax:703-242-1454
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004513101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional