Healthcare Provider Details

I. General information

NPI: 1407029895
Provider Name (Legal Business Name): LANCE ROBERT NELSON M.A. L.P.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 SARDIS RD N STE 207
CHARLOTTE NC
28270-3000
US

IV. Provider business mailing address

1012 ANTIOCH WOODS DR
WEDDINGTON NC
28104-7406
US

V. Phone/Fax

Practice location:
  • Phone: 704-281-7118
  • Fax:
Mailing address:
  • Phone: 704-281-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4806S
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: