Provider Demographics
NPI:1689602922
Name:NOLAN, PATRICK JOSEPH JR (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSEPH
Last Name:NOLAN
Suffix:JR
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLEANDER DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6805
Mailing Address - Country:US
Mailing Address - Phone:910-392-5889
Mailing Address - Fax:910-392-6869
Practice Address - Street 1:4000 OLEANDER DR STE 2A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6805
Practice Address - Country:US
Practice Address - Phone:910-392-5889
Practice Address - Fax:910-392-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102380Medicaid
NC1292NMedicare UPIN