Provider Demographics
NPI:1104273572
Name:NELSON, TANNA (MA, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:TANNA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ASHCRAFT LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2423
Mailing Address - Country:US
Mailing Address - Phone:641-780-5911
Mailing Address - Fax:
Practice Address - Street 1:1300 ASHCRAFT LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2423
Practice Address - Country:US
Practice Address - Phone:641-780-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health