Provider Demographics
NPI:1467197095
Name:NOLAN, BONNIE (PHD,LCADC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PHD,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STOKES LN
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-2707
Mailing Address - Country:US
Mailing Address - Phone:908-380-5103
Mailing Address - Fax:
Practice Address - Street 1:19 STOKES LN
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-2707
Practice Address - Country:US
Practice Address - Phone:908-380-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00351600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00351600OtherLICENSE