Provider Demographics
NPI:1437394640
Name:NEAL, CARRIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 JAGUAR DR
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3180
Mailing Address - Country:US
Mailing Address - Phone:304-433-8493
Mailing Address - Fax:888-315-5319
Practice Address - Street 1:182 JAGUAR DR
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-3180
Practice Address - Country:US
Practice Address - Phone:304-433-8493
Practice Address - Fax:888-315-5319
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1/4/1970103K00000X
WV1-04-1970103K00000X
VA1-04-1970103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst