Provider Demographics
NPI:1902385206
Name:MCKEAL, JOHN DANIEL (MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
Last Name:MCKEAL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 HAWTHORN LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8038
Mailing Address - Country:US
Mailing Address - Phone:561-379-2737
Mailing Address - Fax:
Practice Address - Street 1:5840 HAWTHORN LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-8038
Practice Address - Country:US
Practice Address - Phone:561-379-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH19018101YM0800X
VA0701011072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health