Provider Demographics
NPI:1992356745
Name:KOLB, LORI LYNN (MT-BC, LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:KOLB
Suffix:
Gender:F
Credentials:MT-BC, LPC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:DE REA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:2847 EAGLE NEST LN
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-1461
Mailing Address - Country:US
Mailing Address - Phone:610-597-0491
Mailing Address - Fax:
Practice Address - Street 1:2847 EAGLE NEST LN
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-1461
Practice Address - Country:US
Practice Address - Phone:610-597-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health