Healthcare Provider Details

I. General information

NPI: 1780694844
Provider Name (Legal Business Name): LORI L NELSON LPC LMHC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 CECIL STREET
THOMASVILLE GA
31792-5608
US

IV. Provider business mailing address

PO BOX 2446
THOMASVILLE GA
31799-2446
US

V. Phone/Fax

Practice location:
  • Phone: 229-227-1295
  • Fax: 229-227-1616
Mailing address:
  • Phone: 229-227-1295
  • Fax: 229-227-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6282
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3131
License Number StateGA

VIII. Authorized Official

Name: MS. LORI L NELSON
Title or Position: OWNER LPC LMHC
Credential: MS ED S
Phone: 229-227-1295