Provider Demographics
NPI:1407029895
Name:NELSON, LANCE ROBERT (MA LPCS)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:ROBERT
Last Name:NELSON
Suffix:
Gender:M
Credentials:MA LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 ANTIOCH WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7406
Mailing Address - Country:US
Mailing Address - Phone:704-281-7118
Mailing Address - Fax:
Practice Address - Street 1:1811 SARDIS RD N STE 207
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-3000
Practice Address - Country:US
Practice Address - Phone:704-281-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4806S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional