Provider Demographics
NPI:1285877092
Name:NEALEY, DENISE J (MS)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:J
Last Name:NEALEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4101
Mailing Address - Country:US
Mailing Address - Phone:904-824-7597
Mailing Address - Fax:904-824-7598
Practice Address - Street 1:165 SOUTHPARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4101
Practice Address - Country:US
Practice Address - Phone:904-824-7597
Practice Address - Fax:904-824-7598
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001OtherMASTER OF SCIENCE