Provider Demographics
NPI:1720221591
Name:NELSEN, GAIL MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:MARIE
Last Name:NELSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0222
Mailing Address - Country:US
Mailing Address - Phone:530-574-4336
Mailing Address - Fax:
Practice Address - Street 1:212 GRANDE AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0222
Practice Address - Country:US
Practice Address - Phone:530-574-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical