Healthcare Provider Details

I. General information

NPI: 1841372984
Provider Name (Legal Business Name): CAROLE W NELSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLE W NELSON LPC

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 PINEVIEW DR
VALDOSTA GA
31602-7316
US

IV. Provider business mailing address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

V. Phone/Fax

Practice location:
  • Phone: 229-671-6689
  • Fax: 229-244-6194
Mailing address:
  • Phone: 229-259-4139
  • Fax: 229-259-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number004066
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: