MEDICARE: LORI NICOLAYSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A21696	NC

General Provider Information

NPI Number	:	1619845286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI NICOLAYSEN

Provider Business Mailing Address
First Line	:	1316 BROAD ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3533
Country	:	US
Telephone Number	:	919-885-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 BROAD ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3533
Country	:	US
Telephone Number	:	919-885-6366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	03/12/2026

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Directions to “ LORI NICOLAYSEN ” Practice Location

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