Provider Demographics
NPI:1932132461
Name:NOLDER, MARK ELWOOD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELWOOD
Last Name:NOLDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 EMMORTON RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2582
Mailing Address - Country:US
Mailing Address - Phone:410-477-1800
Mailing Address - Fax:410-477-7053
Practice Address - Street 1:9600 N POINT RD
Practice Address - Street 2:FT HOWARD VA CBOC
Practice Address - City:FORT HOWARD
Practice Address - State:MD
Practice Address - Zip Code:21052-3050
Practice Address - Country:US
Practice Address - Phone:410-477-1800
Practice Address - Fax:410-477-7053
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02850103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling