Provider Demographics
NPI:1669640454
Name:NEELY, JULIUS JOE (PHD)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:JOE
Last Name:NEELY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 WEST EVANS STREET
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3409
Mailing Address - Country:US
Mailing Address - Phone:843-667-4432
Mailing Address - Fax:843-665-9282
Practice Address - Street 1:605 WEST EVANS STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3409
Practice Address - Country:US
Practice Address - Phone:843-667-4432
Practice Address - Fax:843-665-9282
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC356103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0038Medicaid