Provider Demographics
NPI:1740466119
Name:NOLAN, SHELLY ANNE (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:ANNE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NEW BRITAIN AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1100
Mailing Address - Country:US
Mailing Address - Phone:860-573-2564
Mailing Address - Fax:
Practice Address - Street 1:21 NEW BRITAIN AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1100
Practice Address - Country:US
Practice Address - Phone:860-573-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT1931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor