Provider Demographics
NPI:1356174361
Name:NICOLAI, KARYN LEE (LPC)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:LEE
Last Name:NICOLAI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CEDAR BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:NATURAL BRIDGE STATION
Mailing Address - State:VA
Mailing Address - Zip Code:24579-3165
Mailing Address - Country:US
Mailing Address - Phone:540-784-8205
Mailing Address - Fax:
Practice Address - Street 1:1809 MAGNOLIA AVE STE B
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-3235
Practice Address - Country:US
Practice Address - Phone:540-784-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013855101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty