Provider Demographics
NPI:1447004379
Name:NEAL, MARSHALL DAVID (LADAC-II LCDC)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:DAVID
Last Name:NEAL
Suffix:
Gender:M
Credentials:LADAC-II LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 OLD LEBANON DIRT RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-4402
Mailing Address - Country:US
Mailing Address - Phone:512-988-2434
Mailing Address - Fax:
Practice Address - Street 1:731 OLD LEBANON DIRT RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-4402
Practice Address - Country:US
Practice Address - Phone:512-988-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000001612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty