Provider Demographics
NPI:1558382036
Name:NELSON, SUSAN M (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 FOREST HILL AVE
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6867
Mailing Address - Country:US
Mailing Address - Phone:804-323-3262
Mailing Address - Fax:804-330-3827
Practice Address - Street 1:9200 FOREST HILL AVE
Practice Address - Street 2:SUITE C-2
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6867
Practice Address - Country:US
Practice Address - Phone:804-323-3262
Practice Address - Fax:804-330-3827
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAR65668Medicare UPIN
VA800002257Medicare ID - Type Unspecified