Healthcare Provider Details

I. General information

NPI: 1609701119
Provider Name (Legal Business Name): AUSTIN NELSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 OLD PLANTATION DR
LYNCHBURG VA
24502-6963
US

IV. Provider business mailing address

3823 MOORMAN DR
LYNCHBURG VA
24501-3133
US

V. Phone/Fax

Practice location:
  • Phone: 434-515-0423
  • Fax:
Mailing address:
  • Phone: 434-515-0423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016284
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: