| Doctor Name: | DR. KENNETH NEAL |
| NPI Number: | 1053596742 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | PSY003536 |
| Business Practice Address: | 101 Riverstone Vis 211 Blue Ridge, GA - 305136665 |
| Business Phone Number: | 7066323670 |
| Business Fax Number: | 7066323585 |
| Mailing Address: | 101 Riverstone Vista, Suite 205 BLUE RIDGE |
| State: | GA |
| Postal Code: | 305136648 |
| Phone Number: | 7066323670 |
| Fax Number: | 7066323585 |
| NPI Enumeration Date: | 01/01/2008 |
| NPI Last Update Date: | 12/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY003536 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |