Provider Demographics
NPI:1225130529
Name:NELSON, NICOLE ANN (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8037 FAIR OAKS BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6742
Mailing Address - Country:US
Mailing Address - Phone:916-944-3782
Mailing Address - Fax:
Practice Address - Street 1:949 UNIVERSITY AVE STE 101
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6728
Practice Address - Country:US
Practice Address - Phone:916-944-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist