Provider Demographics
NPI:1649922824
Name:NELSON, BRANDON ALAN (CDCA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ALAN
Last Name:NELSON
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 DELAWARE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6475
Mailing Address - Country:US
Mailing Address - Phone:740-736-2033
Mailing Address - Fax:740-251-4748
Practice Address - Street 1:1199 DELAWARE AVE STE 110
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6475
Practice Address - Country:US
Practice Address - Phone:740-736-2033
Practice Address - Fax:740-251-4748
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.183350101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)