Healthcare Provider Details

I. General information

NPI: 1841110822
Provider Name (Legal Business Name): GERNECIE MONDESTIN-NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3383 HENDERSON DR
JACKSONVILLE NC
28546-5231
US

IV. Provider business mailing address

104 FLORA FIELD DR
JACKSONVILLE NC
28546-0180
US

V. Phone/Fax

Practice location:
  • Phone: 252-999-0584
  • Fax:
Mailing address:
  • Phone: 561-702-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: