Provider Demographics
NPI:1255571519
Name:NELSON-HARRIS, GEORGIA ELLEN (BSW, MA SCHOOL COUNS)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:ELLEN
Last Name:NELSON-HARRIS
Suffix:
Gender:F
Credentials:BSW, MA SCHOOL COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DELTA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2334
Mailing Address - Country:US
Mailing Address - Phone:859-663-6393
Mailing Address - Fax:
Practice Address - Street 1:4150 ALEXANDRIA PIKE STE 108
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-3500
Practice Address - Country:US
Practice Address - Phone:859-572-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker