Healthcare Provider Details

I. General information

NPI: 1407946874
Provider Name (Legal Business Name): REBECCA A NELSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 KENMORE DRIVE
DANVILLE WV
25053
US

IV. Provider business mailing address

3375 US RT 60 E
HUNTINGTON WV
25705
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7851
  • Fax: 304-525-1073
Mailing address:
  • Phone: 304-525-7851
  • Fax: 304-525-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberAP00942191
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: