Healthcare Provider Details

I. General information

NPI: 1427591643
Provider Name (Legal Business Name): MONECIA MICHELLE NELMS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE NELMS LCPC

II. Dates (important events)

Enumeration Date: 11/19/2016
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20925 PROFESSIONAL PLAZA, SUITE #320
ASHBURN VA
20147
US

IV. Provider business mailing address

20925 PROFESSIONAL PLAZA, SUITE #320
ASHBURN VA
20147
US

V. Phone/Fax

Practice location:
  • Phone: 410-382-1450
  • Fax:
Mailing address:
  • Phone: 410-382-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701008587
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC7481
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC7481
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: