Provider Demographics
NPI:1912681826
Name:KORINEK, NICOLE (LAPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KORINEK
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 45TH ST S STE 4A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8408
Mailing Address - Country:US
Mailing Address - Phone:701-532-1477
Mailing Address - Fax:
Practice Address - Street 1:2311 45TH ST S STE 4A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8408
Practice Address - Country:US
Practice Address - Phone:701-532-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1300-6-1-23A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health