Provider Demographics
NPI:1184877938
Name:NOLEN, PEGGY (LPC)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
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 1:2107 EMORY ST. NW
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3541
Mailing Address - Country:US
Mailing Address - Phone:770-314-5924
Mailing Address - Fax:770-787-4229
Practice Address - Street 1:2107 EMORY ST. NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3541
Practice Address - Country:US
Practice Address - Phone:770-314-5924
Practice Address - Fax:770-787-4229
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004701101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional