Provider Demographics
NPI:1306220850
Name:NELSON-SMITH, EVONNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:EVONNE
Middle Name:
Last Name:NELSON-SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12546 WEEPING BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9604
Mailing Address - Country:US
Mailing Address - Phone:678-787-8249
Mailing Address - Fax:
Practice Address - Street 1:12546 WEEPING BRANCH CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9604
Practice Address - Country:US
Practice Address - Phone:678-787-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010226101YM0800X
GAAPC004337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health