Individual
MS. CARRIE JUANITA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D, LICSW-PIP, MFT
Contact information
Practice address
4252 CARMICHAEL RD STE 107-108, MONTGOMERY, AL 36106-2804
(334) 356-4960
(334) 356-4961
Mailing address
4252 CARMICHAEL RD STE 107-108, MONTGOMERY, AL 36106-2804
(334) 356-4960
(334) 356-4961
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1646C
AL
1041C0700X
Clinical Social Worker
0759-1646-C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932256328
—
AL
Enumeration date
01/05/2007
Last updated
09/24/2020
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