Provider Demographics
NPI:1912237488
Name:NELSON, NATASHA K (NATASHA NELSON, PSYD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:K
Last Name:NELSON
Suffix:
Gender:F
Credentials:NATASHA NELSON, PSYD
Other - Prefix:
Other - First Name:INFINITE
Other - Middle Name:
Other - Last Name:POTENTIAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 92325
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20090-2325
Mailing Address - Country:US
Mailing Address - Phone:347-489-0664
Mailing Address - Fax:
Practice Address - Street 1:10001 DEREKWOOD LN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4804
Practice Address - Country:US
Practice Address - Phone:347-489-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent