Provider Demographics
NPI:1568741080
Name:NEALY, AUDREY NICOLE GATES (MS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:NICOLE GATES
Last Name:NEALY
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 GRETNA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8932
Mailing Address - Country:US
Mailing Address - Phone:252-258-4322
Mailing Address - Fax:866-744-5379
Practice Address - Street 1:1817 GRETNA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8932
Practice Address - Country:US
Practice Address - Phone:252-258-4322
Practice Address - Fax:866-744-5379
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional