MEDICARE: SOPHIRE MARIE NELSON

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	1041C0700X	Clinical Social Worker	C018260	NC

General Provider Information

NPI Number	:	1992278519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIRE MARIE NELSON

Provider Business Mailing Address
First Line	:	1512 RIDGEWOOD AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-5740
Country	:	US
Telephone Number	:	252-521-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 E W T HARRIS BLVD STE 109
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3600
Country	:	US
Telephone Number	:	704-269-8263
Fax Number	:

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

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	04/25/2025

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Directions to “ SOPHIRE MARIE NELSON ” Practice Location

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