Provider Demographics
NPI:1922033349
Name:NELSON, SHARON MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:NELSON
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 1:13718 NAIRN CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6553
Mailing Address - Country:US
Mailing Address - Phone:804-748-2867
Mailing Address - Fax:804-862-6158
Practice Address - Street 1:111 MORTON AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2749
Practice Address - Country:US
Practice Address - Phone:804-862-8004
Practice Address - Fax:804-862-6158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health