Provider Demographics
NPI:1750644068
Name:NEVILLE, TIMOTHY BRIAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:BRIAN
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PARK AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2118
Mailing Address - Country:US
Mailing Address - Phone:678-425-9007
Mailing Address - Fax:
Practice Address - Street 1:138 PARK AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2118
Practice Address - Country:US
Practice Address - Phone:678-425-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006641101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health