Healthcare Provider Details

I. General information

NPI: 1588692925
Provider Name (Legal Business Name): DANIEL NELSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PRINCESS ANNE ST SUITE 325
FREDERICKSBURG VA
22401-3353
US

IV. Provider business mailing address

PO BOX 13
PARTLOW VA
22534-0013
US

V. Phone/Fax

Practice location:
  • Phone: 540-369-3549
  • Fax:
Mailing address:
  • Phone: 540-369-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701003910
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: