Provider Demographics
NPI:1306198809
Name:DUCHAC, NEIL EDWIN II (PHD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:EDWIN
Last Name:DUCHAC
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4483
Mailing Address - Country:US
Mailing Address - Phone:419-303-8386
Mailing Address - Fax:
Practice Address - Street 1:269 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4483
Practice Address - Country:US
Practice Address - Phone:419-303-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3591101YM0800X
GALPC006098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health