Basic Information
| Provider Information | |||||||||
| NPI: | 1730621855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | JULIETTE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | SOCIAL WORK | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8181 PROFESSIONAL PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | LANDOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207857219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013064590 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8181 PROFESSIONAL PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | LANDOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207857219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013064590 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2016 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | PRC1144 | DC | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | LG101754 | DC | N | Behavioral Health & Social Service Providers | Social Worker | 1041S0200X | 21632 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.