Provider Demographics
NPI:1386940617
Name:NEAL, PAMELA COLETTE (LICSW, LCSW-C, LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:COLETTE
Last Name:NEAL
Suffix:
Gender:F
Credentials:LICSW, LCSW-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 LAKE PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-7000
Mailing Address - Country:US
Mailing Address - Phone:301-613-0152
Mailing Address - Fax:
Practice Address - Street 1:6500 LAKE PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-7000
Practice Address - Country:US
Practice Address - Phone:240-424-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2015-09-17
Deactivation Date:2013-02-20
Deactivation Code:
Reactivation Date:2015-07-08
Provider Licenses
StateLicense IDTaxonomies
DCLC500789831041C0700X
MD211791041C0700X
VA09040076851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical