Healthcare Provider Details

I. General information

NPI: 1619094521
Provider Name (Legal Business Name): DOUGLAS MCNEAL JR. MHA III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 47TH AVE SUITE 111
SACRAMENTO CA
95824-3923
US

IV. Provider business mailing address

4600 47TH AVE SUITE 111
SACRAMENTO CA
95824-3923
US

V. Phone/Fax

Practice location:
  • Phone: 916-393-1222
  • Fax:
Mailing address:
  • Phone: 916-393-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: