Provider Demographics
NPI:1174593412
Name:NEAL, THOMAS JEFFREY (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEFFREY
Last Name:NEAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 HOLMES RUN PKWY
Mailing Address - Street 2:STE C4
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2860
Mailing Address - Country:US
Mailing Address - Phone:703-379-7350
Mailing Address - Fax:703-379-7352
Practice Address - Street 1:5276 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1404
Practice Address - Country:US
Practice Address - Phone:703-379-3750
Practice Address - Fax:703-379-7352
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0003150103TC0700X
VA0810002252103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical