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General NPI Number Information
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NPI Number | 1639734767
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Entity Type | Individual
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Provider Name | DOTRALEE MCNEAL CBHCM
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Gender | Female
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 835 SYCAMORE ST # H8
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City | TITUSVILLE
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State | FL
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Zip | 32780-7700
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Country | US
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Telephone | 352-431-6337
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 S PARK AVE APT 901
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City | TITUSVILLE
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State | FL
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Zip | 32780-3958
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Country | US
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Telephone | 352-431-6337
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CBHCM102301
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License Number State | FL
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