Provider Demographics
NPI:1821495797
Name:NELSON, LAURENCE RICARDO JR (CADC-D)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:RICARDO
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:CADC-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2129
Mailing Address - Country:US
Mailing Address - Phone:248-259-9181
Mailing Address - Fax:
Practice Address - Street 1:29 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2129
Practice Address - Country:US
Practice Address - Phone:248-259-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICADC-D/MCBAP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)