Provider Demographics
NPI:1851454383
Name:MCNEAL, KIMBRAY NICHOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBRAY
Middle Name:NICHOLE
Last Name:MCNEAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 SNOW EGRET DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7749
Mailing Address - Country:US
Mailing Address - Phone:757-291-7445
Mailing Address - Fax:
Practice Address - Street 1:100 BODIN CIRCLE
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-2941
Practice Address - Country:US
Practice Address - Phone:707-423-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903001464104100000X
SC8445104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker