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1851816193 NPI number — NICOLE AYSSA LOLLIS LCMHC

NPI Number: 1851816193
Health Care Provider/Practitioner: NICOLE AYSSA LOLLIS LCMHC

Information about “1851816193” NPI (NICOLE AYSSA LOLLIS LCMHC) exists in 1851816193 in HTML format HTML  |  1851816193 in plain Text format TXT  |  1851816193 in PDF (Portable Document Format) PDF  |  1851816193 in an XML format XML  formats.

NPI Number : 1851816193 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851816193",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOLLIS",
    "FirstName": "NICOLE",
    "MiddleName": "AYSSA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCMHC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HERNANDEZ",
    "OtherFirstName": "NICOLE",
    "OtherMiddleName": "AYSSA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCMHC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 60447",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28260-0447",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "336-564-4950",
    "MailingAddressFaxNumber": "336-564-4959",
    "FirstLinePracticeLocationAddress": "1730 KERNERSVILLE MEDICAL PKWY STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KERNERSVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27284-7198",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-564-4950",
    "PracticeLocationAddressFaxNumber": "336-564-4959",
    "EnumerationDate": "08/08/2017",
    "LastUpdateDate": "10/29/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "13006",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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