Provider Demographics
NPI:1295163517
Name:NELSON, DAVID GRAHAM (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GRAHAM
Last Name:NELSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 HARDENDORF AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1780
Mailing Address - Country:US
Mailing Address - Phone:404-295-0073
Mailing Address - Fax:
Practice Address - Street 1:308 CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2506
Practice Address - Country:US
Practice Address - Phone:404-308-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health