Provider Demographics
NPI:1366505646
Name:NIELSEN, JANE LOVELACE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:LOVELACE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MEMORIAL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2658
Mailing Address - Country:US
Mailing Address - Phone:434-845-5944
Mailing Address - Fax:434-385-0840
Practice Address - Street 1:2600 MEMORIAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2658
Practice Address - Country:US
Practice Address - Phone:434-845-5944
Practice Address - Fax:434-385-0840
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA383989OtherANTHEM BCBS INSURANCE