Provider Demographics
NPI:1891028155
Name:NELSON, ERIK DANIEL (MA, HSP-PA)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:DANIEL
Last Name:NELSON
Suffix:
Gender:M
Credentials:MA, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509A W FRIENDLY AVE
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4269
Mailing Address - Country:US
Mailing Address - Phone:336-297-1060
Mailing Address - Fax:
Practice Address - Street 1:5509A W FRIENDLY AVE
Practice Address - Street 2:SUITE 202A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4269
Practice Address - Country:US
Practice Address - Phone:336-297-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3899103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral