Provider Demographics
NPI:1003337676
Name:NELMS, MARY (CAP, ICADC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NELMS
Suffix:
Gender:F
Credentials:CAP, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6805
Mailing Address - Country:US
Mailing Address - Phone:754-367-6768
Mailing Address - Fax:
Practice Address - Street 1:2832 NE 13TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6805
Practice Address - Country:US
Practice Address - Phone:754-367-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty