Provider Demographics
NPI:1235704958
Name:NEAL, INDIYA NERRIAH
Entity Type:Individual
Prefix:
First Name:INDIYA
Middle Name:NERRIAH
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 TYGERDALE LN
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9118
Mailing Address - Country:US
Mailing Address - Phone:864-553-9618
Mailing Address - Fax:
Practice Address - Street 1:3205 NEW HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6513
Practice Address - Country:US
Practice Address - Phone:985-652-1809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health