Provider Demographics
NPI:1306125661
Name:NELSON, JOANN M (LPC; LMHC)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC; LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 POLAR BEAR CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4432
Mailing Address - Country:US
Mailing Address - Phone:301-645-3985
Mailing Address - Fax:
Practice Address - Street 1:15941 DONALD CURTIS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4256
Practice Address - Country:US
Practice Address - Phone:301-645-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6144101YP2500X
VA071004956101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional