Provider Demographics
NPI:1245380666
Name:NELSON, ADA RUTH (LAC)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:RUTH
Last Name:NELSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4440 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3529
Mailing Address - Country:US
Mailing Address - Phone:504-361-6500
Mailing Address - Fax:504-361-6489
Practice Address - Street 1:18434 N 99TH AVE STE 8
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-1672
Practice Address - Country:US
Practice Address - Phone:623-248-4104
Practice Address - Fax:623-248-4943
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA423101YA0400X
LA9400104100000X
AZLISAC-155255101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker