Provider Demographics
NPI:1831703545
Name:NELSON, REKITA (MA, LMHP-R, LPC-R)
Entity type:Individual
Prefix:
First Name:REKITA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, LMHP-R, LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MONTICELLO MEWS APT 301
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2783
Mailing Address - Country:US
Mailing Address - Phone:757-660-0515
Mailing Address - Fax:
Practice Address - Street 1:11830 CANON BLVD STE C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2568
Practice Address - Country:US
Practice Address - Phone:757-660-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty