MEDICARE: MR. LANCE ROBERT NELSON M.A. L.P.C.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4806S	NC

General Provider Information

NPI Number	:	1407029895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LANCE ROBERT NELSON M.A. L.P.C.S.

Provider Business Mailing Address
First Line	:	1012 ANTIOCH WOODS DR
Second Line	:
City	:	WEDDINGTON
State	:	NC
Zip	:	28104-7406
Country	:	US
Telephone Number	:	704-281-7118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 SARDIS RD N STE 207
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-3000
Country	:	US
Telephone Number	:	704-281-7118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	01/16/2019

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