Provider Demographics
NPI:1790814473
Name:NELSON, VALANDA L (MM,, MT-BC, LCAS, CC)
Entity Type:Individual
Prefix:MS
First Name:VALANDA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:MM,, MT-BC, LCAS, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 VALLIE LANE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2796
Mailing Address - Country:US
Mailing Address - Phone:910-452-1841
Mailing Address - Fax:
Practice Address - Street 1:460 VALLIE LANE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2796
Practice Address - Country:US
Practice Address - Phone:910-452-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC736101YA0400X
NC05036225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist