Individual
IDA M NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
2000 MECKLENBURG ST, RICHMOND, VA 23223-3716
(804) 249-1055
Mailing address
PO BOX 793, MECHANICSVILLE, VA 23111-0793
(804) 363-8964
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710102443
VA
Other
Enumeration date
02/13/2012
Last updated
02/13/2012
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