Provider Demographics
NPI:1497182810
Name:NELSON, JOANNE (MA)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JOANIE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1687 KRONEN WAY
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463
Mailing Address - Country:US
Mailing Address - Phone:805-598-2028
Mailing Address - Fax:
Practice Address - Street 1:1687 KRONEN WAY
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2155
Practice Address - Country:US
Practice Address - Phone:805-598-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YOOOOOX-COUNSELORMedicaid