Individual
MS. SARA L NICOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, LAC
Contact information
Practice address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Mailing address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1516
ND
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025218
BCBS OF ND PIN
ND
Enumeration date
08/13/2006
Last updated
10/07/2020
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