Provider Demographics
NPI:1518457605
Name:MCKEAL, ALYSE HELENE ERGOOD (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:HELENE ERGOOD
Last Name:MCKEAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 4TH ST N STE 8058
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:856-438-0694
Mailing Address - Fax:
Practice Address - Street 1:1769 JAMESTOWN RD STE 207
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2307
Practice Address - Country:US
Practice Address - Phone:856-438-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical