Basic Information
| Provider Information | |||||||||
| NPI: | 1285765610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3345 4TH ST BLVD NW | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282283365 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2359 SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282569855 | ||||||||
| FaxNumber: | 8282561255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C000968 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.