Provider Demographics
NPI:1588692925
Name:NELSON, DANIEL (LPC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
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:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:PARTLOW
Mailing Address - State:VA
Mailing Address - Zip Code:22534-0013
Mailing Address - Country:US
Mailing Address - Phone:540-369-3549
Mailing Address - Fax:
Practice Address - Street 1:2217 PRINCESS ANNE ST
Practice Address - Street 2:SUITE 325
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3353
Practice Address - Country:US
Practice Address - Phone:540-369-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188880OtherTRIGON
VA010238242Medicaid
VA087779MOtherSENTARA
VA010238242OtherVIRGINIA PREMIER