Provider Demographics
NPI:1437172798
Name:LAURAIN, NICOLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:LAURAIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LAURAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:15420 19 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6338
Mailing Address - Country:US
Mailing Address - Phone:586-226-7007
Mailing Address - Fax:
Practice Address - Street 1:15420 19 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6338
Practice Address - Country:US
Practice Address - Phone:586-226-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008909103T00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103T00000XBehavioral Health & Social Service ProvidersPsychologist