Provider Demographics
NPI:1023827433
Name:NELSON, BREA SIMONE
Entity type:Individual
Prefix:
First Name:BREA
Middle Name:SIMONE
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 1:1975 RAMBLING DR SW UNIT 417
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-5959
Mailing Address - Country:US
Mailing Address - Phone:678-396-2397
Mailing Address - Fax:
Practice Address - Street 1:1975 RAMBLING DR SW UNIT 417
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5959
Practice Address - Country:US
Practice Address - Phone:678-396-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician