Provider Demographics
NPI:1508249608
Name:NIELSEN, STEVEN KENNETH (EDD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KENNETH
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DUNCRAIG DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5789
Mailing Address - Country:US
Mailing Address - Phone:434-444-0738
Mailing Address - Fax:434-237-4307
Practice Address - Street 1:101 DUNCRAIG DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5789
Practice Address - Country:US
Practice Address - Phone:434-444-0738
Practice Address - Fax:434-237-4307
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical