Provider Demographics
NPI:1578919486
Name:NEALIOUS, NANCY M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:NEALIOUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10580 LIGON MILL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6090
Mailing Address - Country:US
Mailing Address - Phone:919-263-9592
Mailing Address - Fax:919-263-9670
Practice Address - Street 1:10580 LIGON MILL RD STE 210
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-263-9592
Practice Address - Fax:919-263-9670
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0710097903103TC0700X
NC5591103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical