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General NPI Number Information
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NPI Number | 1457655185
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Entity Type | Individual
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Provider Name | LISA M NICHOLSON
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Gender | Female
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 5221 PARAMOUNT PKWY STE 220
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City | MORRISVILLE
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State | NC
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Zip | 27560-5490
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Country | US
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Telephone | 984-215-6641
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Fax | 984-215-4053
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Provider Business Mailing Address
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Address Line | 212 CARMEN LN SUITE 201
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City | SANTA MARIA
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State | CA
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Zip | 93458-7769
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Country | US
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Telephone | 805-739-8706
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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 | C011899
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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