Provider Demographics
NPI:1508266974
Name:NELSON, LAEBONY (LCSWA)
Entity Type:Individual
Prefix:
First Name:LAEBONY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 CRESCENT COMMONS WAY
Mailing Address - Street 2:APT 304
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6806
Mailing Address - Country:US
Mailing Address - Phone:803-566-6830
Mailing Address - Fax:
Practice Address - Street 1:1480 MAPLE GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-7692
Practice Address - Country:US
Practice Address - Phone:910-567-6194
Practice Address - Fax:910-867-4600
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P0159391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical