Healthcare Provider Details

I. General information

NPI: 1487993549
Provider Name (Legal Business Name): LINDSEY H NOLAN BHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

2610 COMMONS BLVD
AUGUSTA GA
30909-2080
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-7893
  • Fax: 706-432-3780
Mailing address:
  • Phone: 706-733-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC008524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: