Provider Demographics
NPI:1417430075
Name:NOLLENBERGER, ASHLEY MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:NOLLENBERGER
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 1:6225 SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-4916
Mailing Address - Country:US
Mailing Address - Phone:470-253-4557
Mailing Address - Fax:
Practice Address - Street 1:104 PILGRIM VILLAGE DR STE 300
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9232
Practice Address - Country:US
Practice Address - Phone:470-253-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional