Healthcare Provider Details

I. General information

NPI: 1730670183
Provider Name (Legal Business Name): MARCIA NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N PARK RD STE L
WYOMISSING PA
19610-2920
US

IV. Provider business mailing address

812 ELM ST
LAURELDALE PA
19605-1456
US

V. Phone/Fax

Practice location:
  • Phone: 610-396-7272
  • Fax:
Mailing address:
  • Phone: 610-945-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: