Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0810004105 | VA |
N | 103TC1900X | Counseling Psychologist | PSY00347 | GA |
NPI | 1073704714 |
---|---|
Provider Name | Stella Devon Nelms |
First Address | Decatur, GA 30030-4327 |
Second Address | Decatur, GA 30033-4004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 12/03/2019 |