Healthcare Provider Details

I. General information

NPI: 1548430176
Provider Name (Legal Business Name): NELSON JONES IV M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 RIVERS ST
GREENWOOD SC
29649-8513
US

IV. Provider business mailing address

1612 RIVERS ST
GREENWOOD SC
29649-8513
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-1001
  • Fax: 864-227-3619
Mailing address:
  • Phone: 864-227-1001
  • Fax: 864-227-3619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1206145
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: