| Doctor Name: | CAROLYN LANTZY NELSON |
| NPI Number: | 1770570574 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW-C, CAC-AD |
| License Number: | AC1178 |
| Business Practice Address: | 6045 Solomons Island Rd Huntingtown, MD - 206398876 |
| Business Phone Number: | 4102575200 |
| Business Fax Number: | 4102572442 |
| Mailing Address: | 6045 Solomons Island Rd, HUNTINGTOWN |
| State: | MD |
| Postal Code: | 206398876 |
| Phone Number: | 4102575200 |
| Fax Number: | 4102572442 |
| NPI Enumeration Date: | 10/05/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | AC1178 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |