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General NPI Number Information
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NPI Number | 1114777265
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Entity Type | Individual
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Provider Name | KAMMEAKO NICOLE MCNEIL MHC
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Gender | Female
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 4138 ROCKY FORK TER
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City | ELLENTON
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State | FL
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Zip | 34222-7233
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Country | US
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Telephone | 941-529-6812
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 6TH AVE W STE 100
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City | BRADENTON
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State | FL
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Zip | 34205-7413
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Country | US
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Telephone | 941-281-6945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | FL
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