Provider Demographics
NPI:1750828380
Name:NEALON, VONNIE
Entity Type:Individual
Prefix:
First Name:VONNIE
Middle Name:
Last Name:NEALON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 TRACKS TRAIL
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:TX
Mailing Address - Zip Code:78010
Mailing Address - Country:US
Mailing Address - Phone:210-872-3890
Mailing Address - Fax:
Practice Address - Street 1:756 PURPLE SAGE RD
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:210-872-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8346101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)