Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003075458 |
---|---|
Provider Name | Joe Neal |
First Address | Cape Girardeau, MO 63703-6212 |
Second Address | Cape Girardeau, MO 63703-6212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 02/06/2008 |