Provider Demographics
NPI:1003244716
Name:NELSON, SANDRA (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:NELSON
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 1:633 HIGHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9004
Mailing Address - Country:US
Mailing Address - Phone:843-300-9105
Mailing Address - Fax:
Practice Address - Street 1:782 JOHNNIE DODDS BLVD STE I
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3051
Practice Address - Country:US
Practice Address - Phone:843-300-9105
Practice Address - Fax:843-284-3931
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5595OtherSOUTH CAROLINA DEPARTMENT OF LABOR AND LICENSING: LPC