Provider Demographics
NPI:1467751818
Name:NELSON, HOLLY A (ASW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-5990
Mailing Address - Fax:858-966-7508
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:3020 CHILDREN'S WAY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5990
Practice Address - Fax:858-966-7508
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29962171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator