Provider Demographics
NPI:1285180109
Name:NELSON, JENETTA R (MSW)
Entity Type:Individual
Prefix:
First Name:JENETTA
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 GOODBREAD LANE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303
Mailing Address - Country:US
Mailing Address - Phone:404-437-1301
Mailing Address - Fax:
Practice Address - Street 1:807 GOODBREAD LANE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:404-437-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker