Healthcare Provider Details

I. General information

NPI: 1316567654
Provider Name (Legal Business Name): CHERYL D NELSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HENRY AVE STE 302
PHILADELPHIA PA
19129-1314
US

IV. Provider business mailing address

5525 PULASKI AVE
PHILADELPHIA PA
19144-3811
US

V. Phone/Fax

Practice location:
  • Phone: 215-924-0684
  • Fax:
Mailing address:
  • Phone: 215-806-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: