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General NPI Number Information
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NPI Number | 1639715782
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Entity Type | Individual
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Provider Name | NADINE COLEEN OLDHAM LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 2785 LAWRENCEVILLE HWY STE 205
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City | DECATUR
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State | GA
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Zip | 30033-2515
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Country | US
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Telephone | 404-371-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 DUNWOODY CLUB DR UNIT 10
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City | DUNWOODY
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State | GA
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Zip | 30350-5200
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Country | US
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Telephone | 646-316-3418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006597
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License Number State | GA
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