Carrie Juanita Nelson, PH.D, LICSW-PIP, MFT

Primary specialty

Social WorkerTaxonomy code 104100000X

License

1646C Issued in AL

Practice address

4252 Carmichael Rd Ste 107-108
Montgomery, AL 36106-2804

Phone

(334) 356-4960

Fax

(334) 356-4961

NPI assigned

Jan 5, 2007

Last updated

Sep 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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

• Haven Intergrative Therapy Center, LLC

  • Mental Health Counselor
  • Montgomery, AL
  • NPI 1730602996
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1932256328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4252 CARMICHAEL RD STE 107-108",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062804",
            "telephone_number": "334-356-4960",
            "fax_number": "334-356-4961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4252 CARMICHAEL RD STE 107-108",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062804",
            "telephone_number": "334-356-4960",
            "fax_number": "334-356-4961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "CARRIE",
        "middle_name": "JUANITA",
        "name_prefix": "Ms.",
        "credential": "PH.D, LICSW-PIP, MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AL",
            "license": "1646C",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "0759-1646-C",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932256328",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Blair Neeland, M.D.
• Nils Pontus Neglen, PT
• Lynsey Johnson Neighbors, PHARMD
• John D Neill, D.C.
• Nina Patrice Nelson-Garrett, M.D.
• Gregory T Nelson, O.D.
• Jayla Nelson
• Marietta Nero, CRNP
• Nes Tennessee Inc
• Net Al

• Social Worker in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.