Provider Demographics
NPI:1659814937
Name:NICOLSEN, TONI (LMFTA)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:NICOLSEN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 HIGHWAY 54 WEST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:919-438-1942
Mailing Address - Fax:
Practice Address - Street 1:1502 HIGHWAY 54 WEST
Practice Address - Street 2:SUITE 505
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-438-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12008A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist