Provider Demographics
NPI:1174397723
Name:ONEAL, DESIREE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:ONEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 COUNTY ROAD 46
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-4844
Mailing Address - Country:US
Mailing Address - Phone:334-421-4180
Mailing Address - Fax:
Practice Address - Street 1:95 COUNTY ROAD 46
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-4844
Practice Address - Country:US
Practice Address - Phone:334-421-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5494G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker