Provider Demographics
NPI:1689064131
Name:NELSON, DAVID ALLEN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0395
Mailing Address - Country:US
Mailing Address - Phone:304-417-4929
Mailing Address - Fax:
Practice Address - Street 1:113 SETZER DR
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1123
Practice Address - Country:US
Practice Address - Phone:304-417-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001820-SUPV101YP2500X
OHI.0008643-SUPV1041C0700X
WVDP009422761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional