Provider Demographics
NPI:1639349467
Name:NELSON, TERI LYN (LCPC)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LYN
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:LYN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:6040 PUBLIC LANDING ROAD
Mailing Address - Street 2:P.O. BOX 249
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-0249
Mailing Address - Country:US
Mailing Address - Phone:410-632-1100
Mailing Address - Fax:410-632-5682
Practice Address - Street 1:6040 PUBLIC LANDING ROAD
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-0249
Practice Address - Country:US
Practice Address - Phone:410-632-1100
Practice Address - Fax:410-632-5682
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD742LMedicare PIN
MD609550001Medicaid
MD522156095OtherAPS-MD
MD742LMedicare PIN
MD522156095OtherCOMMERCIAL INSURANCE
MDLM49EAOtherCAREFIRST BCBS
MDR968OtherCAREFIRST FEDERAL