Provider Demographics
NPI:1386487486
Name:NELSON, JONATHAN F (MS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:F
Last Name:NELSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 CORAL BERRY RD
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-8298
Mailing Address - Country:US
Mailing Address - Phone:765-609-1063
Mailing Address - Fax:
Practice Address - Street 1:2155 N PARK LN STE 212
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9261
Practice Address - Country:US
Practice Address - Phone:843-410-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional