Provider Demographics
NPI:1891507893
Name:LARSEN, NICHOLAS STEVEN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:STEVEN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:235 CAPELLAN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1310
Mailing Address - Country:US
Mailing Address - Phone:206-459-8825
Mailing Address - Fax:
Practice Address - Street 1:8521 SIX FORKS RD STE 350
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5863
Practice Address - Country:US
Practice Address - Phone:919-676-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician