Provider Demographics
NPI:1578581609
Name:NELSEN, MARILYN JANICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:JANICE
Last Name:NELSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 THORN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-9271
Mailing Address - Country:US
Mailing Address - Phone:919-270-6039
Mailing Address - Fax:
Practice Address - Street 1:1101 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3957
Practice Address - Country:US
Practice Address - Phone:919-270-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1053106H00000X
CA36353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist