Individual provider Active NPI

Sharon Marie Nelson, LCSW

  • Mental Health Counselor
  • Petersburg, VA
National Provider Identifier
1922033349
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
0904001675 Issued in VA
Practice address
111 Morton Ave
Petersburg, VA 23805-2749
Phone
(804) 862-8004
Fax
(804) 862-6158
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 0904001675 VA Primary

Addresses

Primary practice location

111 Morton Ave
Petersburg, VA 23805-2749

Mailing address

13718 Nairn CT
Chester, VA 23831-6553
Phone (804) 748-2867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904001675VAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Health Care, Inc. Past Accepting new patients
District 19 Community Services Board PastSince Oct 5, 2012 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922033349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13718 NAIRN CT",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238316553",
            "telephone_number": "804-748-2867",
            "fax_number": "804-862-6158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MORTON AVE",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052749",
            "telephone_number": "804-862-8004",
            "fax_number": "804-862-6158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "SHARON",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0904001675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.