Provider Demographics
NPI:1992329452
Name:NELSON, ASIA L (RBT)
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 FAIRWAY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1817
Mailing Address - Country:US
Mailing Address - Phone:877-418-2978
Mailing Address - Fax:866-500-2186
Practice Address - Street 1:11055 SW 186TH ST STE 306
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6843
Practice Address - Country:US
Practice Address - Phone:786-224-6884
Practice Address - Fax:786-688-2483
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLISW191261041C0700X
GA19-99111106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician