Provider Demographics
NPI:1295926343
Name:NELSON, CINDY M (LCPC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W FRANKLIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5400
Mailing Address - Country:US
Mailing Address - Phone:208-917-3346
Mailing Address - Fax:208-906-8654
Practice Address - Street 1:208 MALLOY ST
Practice Address - Street 2:UNIT E
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4478
Practice Address - Country:US
Practice Address - Phone:919-778-5594
Practice Address - Fax:919-778-5633
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7771101YM0800X
NM0107881101YM0800X
NC9904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health