Individual
MARY NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW-CP
Contact information
Practice address
500 N MAIN ST, SUMMERVILLE, SC 29483-6439
(843) 871-4790
(843) 871-8579
Mailing address
500 N MAIN ST, SUMMERVILLE, SC 29483-6439
(843) 871-4790
(843) 871-8579
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5548
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5548
LISW-CP LINCENSE
SC
05
—
AD16DO
—
SC
Enumeration date
07/03/2007
Last updated
07/09/2007
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