Provider Demographics
NPI:1013523463
Name:NIEBAUER, LORI H
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:H
Last Name:NIEBAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 ALDERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9292
Mailing Address - Country:US
Mailing Address - Phone:336-905-5135
Mailing Address - Fax:
Practice Address - Street 1:770 PARK CENTRE DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3598
Practice Address - Country:US
Practice Address - Phone:336-905-5135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician