Provider Demographics
NPI:1477211753
Name:NELSON, STERLING HALL (MS, MED)
Entity Type:Individual
Prefix:
First Name:STERLING
Middle Name:HALL
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11745 MOUNTAIN PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1820
Mailing Address - Country:US
Mailing Address - Phone:770-992-7812
Mailing Address - Fax:
Practice Address - Street 1:11745 MOUNTAIN PARK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1820
Practice Address - Country:US
Practice Address - Phone:770-992-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952076721OtherVIRTUAL COUNSELING COMPANY