| Doctor Name: | MARK A NELSON |
| NPI Number: | 1467598599 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | SA COUNSELOR-LASDC |
| License Number: | LC770 |
| Business Practice Address: | 11 Mill St Houlton, ME - 047301877 |
| Business Phone Number: | 2075326523 |
| Business Fax Number: | 2075323873 |
| Mailing Address: | 11 Mill St, HOULTON |
| State: | ME |
| Postal Code: | 047301877 |
| Phone Number: | 2075326523 |
| Fax Number: | 2075323873 |
| NPI Enumeration Date: | 01/29/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LC770 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |