Provider Demographics
NPI:1841372984
Name:NELSON, CAROLE W (LPC)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:W
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:W
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2501 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1735
Mailing Address - Country:US
Mailing Address - Phone:229-259-4139
Mailing Address - Fax:229-259-4925
Practice Address - Street 1:2209 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7316
Practice Address - Country:US
Practice Address - Phone:229-671-6689
Practice Address - Fax:229-244-6194
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional