Provider Demographics
NPI:1245349950
Name:NELSON, BEVERLY L (LCSW BCD)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 RIDGE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229
Mailing Address - Country:US
Mailing Address - Phone:804-288-7242
Mailing Address - Fax:804-288-7243
Practice Address - Street 1:8010 RIDGE RD
Practice Address - Street 2:SUITE D
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229
Practice Address - Country:US
Practice Address - Phone:804-288-7242
Practice Address - Fax:804-288-7243
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040007091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
32329OtherMAMSI
6216760OtherUNITED BEHAVIORAL HEALTH
NG521OtherEMPIRE BCBS
080282OtherSENTARA
132042OtherMANAGED HEALTH NETWORK
5781127OtherAETNA
6280001OtherUNITED BEHAVIORAL HEALTH
692862OtherFIRST HEALTH
179351OtherCOMPSYCH
127542OtherGREEN SPRING
167945OtherSOUTHERN HEALTH
VA8906220Medicaid
230847OtherTRIGON