Provider Demographics
NPI:1528704145
Name:NICHOLSON, LAURIE K (MS, LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:K
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MS, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12438 HONEYCHURCH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8379
Mailing Address - Country:US
Mailing Address - Phone:919-453-3141
Mailing Address - Fax:
Practice Address - Street 1:800 W WILLIAMS ST STE 280
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5203
Practice Address - Country:US
Practice Address - Phone:919-794-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health