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NPI Code Detail

MEDICARE: MS. DAVENE NELSON LCSW

MEDICARE: MS. DAVENE NELSON LCSW
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
11041C0700XClinical Social Worker0904001138VA

General Provider Information

NPI Number : 1790890424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DAVENE NELSON LCSW
Provider Business Mailing Address
First Line : 8119 HOLLAND RD
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22306-3135
Country : US
Telephone Number : 702-799-2811
Fax Number : 703-360-0899
Provider Business Practice Location Address
First Line : 8119 HOLLAND RD
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22306-3135
Country : US
Telephone Number : 703-799-2811
Fax Number : 703-360-0899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/08/2007

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