Provider Demographics
NPI:1588918726
Name:NEAL, AGATHA CHRISTIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:CHRISTIE
Last Name:NEAL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:NEWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28126-0369
Mailing Address - Country:US
Mailing Address - Phone:704-313-9246
Mailing Address - Fax:855-289-0619
Practice Address - Street 1:9700 RESEARCH DR
Practice Address - Street 2:SUITE 128
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8552
Practice Address - Country:US
Practice Address - Phone:704-313-9246
Practice Address - Fax:855-289-0619
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8109101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional