Provider Demographics
NPI:1215423082
Name:CHRISTINE NELSON
Entity type:Organization
Organization Name:CHRISTINE NELSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCED PSYCHOTHERAPIT-CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-286-4507
Mailing Address - Street 1:5616 BELL GWYNN RD # 216
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9343
Mailing Address - Country:US
Mailing Address - Phone:443-286-4507
Mailing Address - Fax:410-527-0646
Practice Address - Street 1:5616 BELL GWYNN RD # 216
Practice Address - Street 2:
Practice Address - City:GLEN ARM
Practice Address - State:MD
Practice Address - Zip Code:21057-9343
Practice Address - Country:US
Practice Address - Phone:443-286-4507
Practice Address - Fax:410-527-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty