Provider Demographics
NPI:1558499418
Name:NELSON, JOAN M (LCSW,BCD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 TRENHOLM DR
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1328
Mailing Address - Country:US
Mailing Address - Phone:703-620-9026
Mailing Address - Fax:
Practice Address - Street 1:10470 ARMSTRONG ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3648
Practice Address - Country:US
Practice Address - Phone:703-385-7575
Practice Address - Fax:703-385-7578
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040003351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical