Provider Demographics
NPI:1114777265
Name:MCNEIL, KAMMEAKO NICOLE (MHC)
Entity Type:Individual
Prefix:
First Name:KAMMEAKO
Middle Name:NICOLE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:MIND OVER
Other - Middle Name:
Other - Last Name:MATTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHC
Mailing Address - Street 1:1201 6TH AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-7413
Mailing Address - Country:US
Mailing Address - Phone:941-281-6945
Mailing Address - Fax:
Practice Address - Street 1:4138 ROCKY FORK TER
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-7233
Practice Address - Country:US
Practice Address - Phone:941-529-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health