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General NPI Number Information
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NPI Number | 1114948551
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Entity Type | Individual
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Provider Name | MICHELLE M NELSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 321 W HILL ST STE 2C
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City | DECATUR
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State | GA
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Zip | 30030-4362
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Country | US
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Telephone | 404-566-7761
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 807
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City | CLARKSTON
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State | GA
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Zip | 30021-0807
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 004103
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License Number State | GA
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