Provider Demographics
NPI:1851793525
Name:MCNEALY, MICHELLE LEVONIA (LMHC-RI)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEVONIA
Last Name:MCNEALY
Suffix:
Gender:F
Credentials:LMHC-RI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 LAFAYETTE ST STE H
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-8229
Mailing Address - Country:US
Mailing Address - Phone:850-775-9478
Mailing Address - Fax:
Practice Address - Street 1:4154 LAFAYETTE ST STE H
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-8229
Practice Address - Country:US
Practice Address - Phone:850-775-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ250552698290OtherDRIVER LISCENSE
FLM254552698290OtherDRIVER LISCENSE