Provider Demographics
NPI:1326088303
Name:CARLSON, NELDA JEAN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:NELDA
Middle Name:JEAN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:MELSON
Other - Middle Name:JEAN
Other - Last Name:BRAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2689 MUIR LN
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-7683
Mailing Address - Country:US
Mailing Address - Phone:850-547-3686
Mailing Address - Fax:
Practice Address - Street 1:1931 HIGHWAY 179A
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:FL
Practice Address - Zip Code:32464-3076
Practice Address - Country:US
Practice Address - Phone:850-849-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1334C1041C0700X
AL0751-1334C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503868OtherBCBS