MEDICARE: MRS. SUSAN M NELSON MSW

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	101YM0800X	Mental Health Counselor	0904000041	VA

General Provider Information

NPI Number	:	1558382036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN M NELSON MSW

Provider Business Mailing Address
First Line	:	9200 FOREST HILL AVE
Second Line	:	SUITE C-2
City	:	RICHMOND
State	:	VA
Zip	:	23235-6867
Country	:	US
Telephone Number	:	804-323-3262
Fax Number	:	804-330-3827

Provider Business Practice Location Address
First Line	:	9200 FOREST HILL AVE
Second Line	:	SUITE C-2
City	:	RICHMOND
State	:	VA
Zip	:	23235-6867
Country	:	US
Telephone Number	:	804-323-3262
Fax Number	:	804-330-3827

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	12/14/2011

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