Provider Demographics
NPI:1417738212
Name:NOLL, KACIE JO (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KACIE
Middle Name:JO
Last Name:NOLL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KACIE
Other - Middle Name:JO
Other - Last Name:LARKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2318 BUTTON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-1408
Mailing Address - Country:US
Mailing Address - Phone:715-417-2235
Mailing Address - Fax:
Practice Address - Street 1:223 DUNBAR CAVE RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8831
Practice Address - Country:US
Practice Address - Phone:931-444-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14749104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker