Provider Demographics
NPI:1629571229
Name:NOLEN, MAIKE (LPC)
Entity Type:Individual
Prefix:
First Name:MAIKE
Middle Name:
Last Name:NOLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9179 FUREY RD
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2967
Mailing Address - Country:US
Mailing Address - Phone:703-655-9140
Mailing Address - Fax:
Practice Address - Street 1:3950 CHAIN BRIDGE RD STE 10
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3935
Practice Address - Country:US
Practice Address - Phone:724-401-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional