Healthcare Provider Details

I. General information

NPI: 1932822756
Provider Name (Legal Business Name): MRS. CHIMNEMEREM NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

CMR 422 BOX 972
APO AE
09067-0010
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-4664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001987
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: