Provider Demographics
NPI:1972191708
Name:NELSON, BILLIE-RAE
Entity Type:Individual
Prefix:
First Name:BILLIE-RAE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 DEMETROPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9602
Mailing Address - Country:US
Mailing Address - Phone:251-219-3900
Mailing Address - Fax:
Practice Address - Street 1:4444 DEMETROPOLIS RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9602
Practice Address - Country:US
Practice Address - Phone:251-219-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2024-02-16
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-06-27
Provider Licenses
StateLicense IDTaxonomies
ALLPC04411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty