Provider Demographics
NPI:1639230493
Name:NEAL, TRENA THOMAS (BSW)
Entity Type:Individual
Prefix:MRS
First Name:TRENA
Middle Name:THOMAS
Last Name:NEAL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-2369
Mailing Address - Country:US
Mailing Address - Phone:404-414-6643
Mailing Address - Fax:770-472-7348
Practice Address - Street 1:412 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4226
Practice Address - Country:US
Practice Address - Phone:404-414-6643
Practice Address - Fax:770-472-7348
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator