Provider Demographics
NPI:1427589449
Name:NOLDEN, THERESA J
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:NOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13037 CORBETT ST # 201
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-2073
Mailing Address - Country:US
Mailing Address - Phone:313-969-7737
Mailing Address - Fax:313-969-7737
Practice Address - Street 1:13037 CORBETT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-2073
Practice Address - Country:US
Practice Address - Phone:313-969-7737
Practice Address - Fax:313-969-7737
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015856101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor