Provider Demographics
NPI:1447013628
Name:NELSON, JEANEEN R (MSW)
Entity type:Individual
Prefix:MRS
First Name:JEANEEN
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 SUMTER HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-5340
Mailing Address - Country:US
Mailing Address - Phone:843-230-9791
Mailing Address - Fax:
Practice Address - Street 1:2341 SUMTER HWY
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-5340
Practice Address - Country:US
Practice Address - Phone:843-230-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker