Provider Demographics
NPI:1477600138
Name:NOLAN, KARA A (CISW)
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:A
Last Name:NOLAN
Suffix:
Gender:F
Credentials:CISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 W BELL RD
Mailing Address - Street 2:SUITE202
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3425
Mailing Address - Country:US
Mailing Address - Phone:602-882-3284
Mailing Address - Fax:602-938-6640
Practice Address - Street 1:4915 W BELL RD
Practice Address - Street 2:SUITE202
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3425
Practice Address - Country:US
Practice Address - Phone:602-882-3284
Practice Address - Fax:602-938-6640
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCISW SW29751104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSW29751OtherCISW
AZSW29751OtherCISW