Provider Demographics
NPI:1023189834
Name:NELSON, RHONNA L (LMSW DCSW)
Entity Type:Individual
Prefix:MRS
First Name:RHONNA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31000 TELEGRAPH ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4306
Mailing Address - Country:US
Mailing Address - Phone:248-723-4114
Mailing Address - Fax:248-723-4766
Practice Address - Street 1:31000 TELEGRAPH ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4306
Practice Address - Country:US
Practice Address - Phone:248-723-4114
Practice Address - Fax:248-723-4766
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010162021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
033244OtherMHS
MION42410Medicare ID - Type Unspecified
033244OtherMHS