Provider Demographics
NPI:1861890931
Name:NELSON, JAIME HORNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:HORNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JAIME
Other - Middle Name:CHARLENE
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2967 SANDY LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-1943
Mailing Address - Country:US
Mailing Address - Phone:470-219-1670
Mailing Address - Fax:
Practice Address - Street 1:1375 IDLEWOOD PARC XING
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7836
Practice Address - Country:US
Practice Address - Phone:470-219-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0049661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical