Provider Demographics
NPI:1689844649
Name:NELSON, ROBERT M (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:NELSON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-3335
Mailing Address - Country:US
Mailing Address - Phone:910-572-4673
Mailing Address - Fax:
Practice Address - Street 1:1011 PAGE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371
Practice Address - Country:US
Practice Address - Phone:910-576-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional