Provider Demographics
NPI:1831329432
Name:ALLEN, NOLAN DWAIN (MA, LMHC)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:DWAIN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26625 NW 3RD PL
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2607
Mailing Address - Country:US
Mailing Address - Phone:352-335-2107
Mailing Address - Fax:
Practice Address - Street 1:5000 NW 27TH CT
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6593
Practice Address - Country:US
Practice Address - Phone:352-335-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health