Provider Demographics
NPI:1245824424
Name:DECOLAINES, NAN W
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:W
Last Name:DECOLAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:HIGH SHOALS
Mailing Address - State:GA
Mailing Address - Zip Code:30645-0143
Mailing Address - Country:US
Mailing Address - Phone:706-202-6549
Mailing Address - Fax:
Practice Address - Street 1:188 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:N HIGH SHOALS
Practice Address - State:GA
Practice Address - Zip Code:30621-1511
Practice Address - Country:US
Practice Address - Phone:706-202-6549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor