Healthcare Provider Details

I. General information

NPI: 1467528927
Provider Name (Legal Business Name): JEFFREY SAMUEL NOLAN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS RD PB1 STE. 334
DETROIT MI
48236-2167
US

IV. Provider business mailing address

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7230
  • Fax: 313-343-7449
Mailing address:
  • Phone: 586-753-0405
  • Fax: 586-753-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: