Provider Demographics
NPI:1518545441
Name:NEELEY, STEPHANIE (CDCA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NEELEY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 EVANS ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45204-2075
Mailing Address - Country:US
Mailing Address - Phone:513-903-6559
Mailing Address - Fax:
Practice Address - Street 1:801 EVANS ST STE 104
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45204-2075
Practice Address - Country:US
Practice Address - Phone:513-903-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.176303101YA0400X
OH0001939175T00000X
OH018719251S00000X
OHCDCA.181898101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1477211423Medicaid