Healthcare Provider Details

I. General information

NPI: 1225138720
Provider Name (Legal Business Name): ROBERT JOSEPH NOLAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTSIDE DR
DOTHAN AL
36303-1908
US

IV. Provider business mailing address

100 WESTSIDE DR
DOTHAN AL
36303-1908
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-2237
  • Fax: 334-712-6256
Mailing address:
  • Phone: 334-793-2237
  • Fax: 334-712-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number283
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number283
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number283
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number283
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number283
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number283
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number283
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number283
License Number StateAL
# 9
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number283
License Number StateAL
# 10
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number283
License Number StateAL
# 11
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number283
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: