Provider Demographics
NPI:1689841462
Name:SANNICOLAS, LAURA HELEN (LMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HELEN
Last Name:SANNICOLAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 FOREST AVE STE 26
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2125
Mailing Address - Country:US
Mailing Address - Phone:949-468-8997
Mailing Address - Fax:949-362-7938
Practice Address - Street 1:332 FOREST AVE STE 26
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2125
Practice Address - Country:US
Practice Address - Phone:949-468-8997
Practice Address - Fax:949-362-7938
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist