Provider Demographics
NPI:1609020387
Name:NELSON, CHERINE (LCSW, CAS)
Entity Type:Individual
Prefix:MISS
First Name:CHERINE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 10071
Mailing Address - Street 2:BX 10071
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDICAL GROUP AF
Practice Address - Street 2:PSC 79 BOX 21225,
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96364-1225
Practice Address - Country:US
Practice Address - Phone:000-634-8849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
DEQ1-00009471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical