Provider Demographics
NPI:1790490654
Name:NEAL, MELISSA R (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:NEAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:557 GLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2024
Mailing Address - Country:US
Mailing Address - Phone:229-233-4308
Mailing Address - Fax:
Practice Address - Street 1:557 GLOVER AVE
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2024
Practice Address - Country:US
Practice Address - Phone:229-233-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6132G101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health