Provider Demographics
NPI:1851441430
Name:LLOYD, NOLIA FOUNTAIN (LLP)
Entity Type:Individual
Prefix:
First Name:NOLIA
Middle Name:FOUNTAIN
Last Name:LLOYD
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:NOLIA
Other - Middle Name:FOUNTAIN
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLP
Mailing Address - Street 1:5555 CONNER ST STE 2818
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3448
Mailing Address - Country:US
Mailing Address - Phone:313-264-6490
Mailing Address - Fax:313-264-6495
Practice Address - Street 1:5555 CONNER ST STE 2818
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3448
Practice Address - Country:US
Practice Address - Phone:313-264-6490
Practice Address - Fax:313-264-6495
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361000436103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist