Provider Demographics
NPI:1255784443
Name:NELSON, CHRISTINE MARIE (LCPC, BCPC, LICENSED)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCPC, BCPC, LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 BELL GWYNN RD. #216
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057
Mailing Address - Country:US
Mailing Address - Phone:443-286-4507
Mailing Address - Fax:866-271-9918
Practice Address - Street 1:5616 BELL GWYNN RD
Practice Address - Street 2:
Practice Address - City:GLEN ARM
Practice Address - State:MD
Practice Address - Zip Code:21057
Practice Address - Country:US
Practice Address - Phone:443-286-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1620101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor