Basic Information
| Provider Information | |||||||||
| NPI: | 1851454383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNEAL | ||||||||
| FirstName: | KIMBRAY | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 385 SNOW EGRET DR | ||||||||
| Address2: | |||||||||
| City: | VACAVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956877749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572917445 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 BODIN CIRCLE | ||||||||
| Address2: | |||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945352941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074235174 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 11/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 0903001464 | VA | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 8445 | SC | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.