Healthcare Provider Details

I. General information

NPI: 1295926343
Provider Name (Legal Business Name): CINDY M. NELSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MALLOY ST UNIT E
GOLDSBORO NC
27534-4478
US

IV. Provider business mailing address

1020 W FRANKLIN ST STE 110
BOISE ID
83702-5400
US

V. Phone/Fax

Practice location:
  • Phone: 919-778-5594
  • Fax: 919-778-5633
Mailing address:
  • Phone: 208-917-3346
  • Fax: 208-906-8654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-7771
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0107881
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9904
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: