Healthcare Provider Details

I. General information

NPI: 1922033349
Provider Name (Legal Business Name): SHARON MARIE NELSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MORTON AVE
PETERSBURG VA
23805-2749
US

IV. Provider business mailing address

13718 NAIRN CT
CHESTER VA
23831-6553
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8004
  • Fax: 804-862-6158
Mailing address:
  • Phone: 804-748-2867
  • Fax: 804-862-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904001675
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: