Provider Demographics
NPI:1174245526
Name:NEELY, DEIDRE LASCHE' (LCSWA)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:LASCHE'
Last Name:NEELY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:LASCHE'
Other - Last Name:NEELY-PEEPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWA
Mailing Address - Street 1:5302 YADKIN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3255
Mailing Address - Country:US
Mailing Address - Phone:910-527-1908
Mailing Address - Fax:910-860-3903
Practice Address - Street 1:515 EATON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4003
Practice Address - Country:US
Practice Address - Phone:910-229-1278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0155171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical