Provider Demographics
NPI:1427591643
Name:NELMS, MONECIA MICHELLE (LCPC)
Entity Type:Individual
Prefix:
First Name:MONECIA
Middle Name:MICHELLE
Last Name:NELMS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:NELMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:20925 PROFESSIONAL PLAZA, SUITE #320
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:410-382-1450
Mailing Address - Fax:
Practice Address - Street 1:20925 PROFESSIONAL PLAZA, SUITE #320
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:410-382-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-19
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008587101Y00000X
MDLC7481101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD115768500Medicaid