Provider Demographics
NPI:1881119584
Name:NOLAN, MICHAEL Q (CADC-II)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:Q
Last Name:NOLAN
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SARATOGA AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3408
Mailing Address - Country:US
Mailing Address - Phone:408-826-7002
Mailing Address - Fax:
Practice Address - Street 1:920 SARATOGA AVE STE 212
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3408
Practice Address - Country:US
Practice Address - Phone:408-826-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA011980315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA011980315OtherCCAPP
CA016103OtherNCCAP