Provider Demographics
NPI:1386195014
Name:NEELEY, DEIRDRE DENISE (LPC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:DENISE
Last Name:NEELEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 GLENRIDGE DR NE
Mailing Address - Street 2:APT 540
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1359
Mailing Address - Country:US
Mailing Address - Phone:770-235-7340
Mailing Address - Fax:
Practice Address - Street 1:5501 GLENRIDGE DR NE
Practice Address - Street 2:APT 540
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1359
Practice Address - Country:US
Practice Address - Phone:770-235-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007659101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor