Provider Demographics
NPI:1588800585
Name:NOLAN, STACY SUSANNE (MSW,GSW)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:SUSANNE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MSW,GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69004
Mailing Address - Street 2:2495 SHREVEPORT HWY 71 NORTH
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-9004
Mailing Address - Country:US
Mailing Address - Phone:318-466-2260
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY 71 NORTH
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71306
Practice Address - Country:US
Practice Address - Phone:318-466-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5343104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker