Provider Demographics
NPI:1639715782
Name:OLDHAM, NADINE COLEEN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:NADINE
Middle Name:COLEEN
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 DUNWOODY CLUB DR UNIT 10
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5200
Mailing Address - Country:US
Mailing Address - Phone:646-316-3418
Mailing Address - Fax:
Practice Address - Street 1:2785 LAWRENCEVILLE HWY STE 205
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2515
Practice Address - Country:US
Practice Address - Phone:404-371-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0065971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical