Provider Demographics
NPI:1174737092
Name:NEALON, JOHN J (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:NEALON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14300 GALLANT FOX LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4003
Mailing Address - Country:US
Mailing Address - Phone:301-464-3590
Mailing Address - Fax:301-464-7357
Practice Address - Street 1:14300 GALLANT FOX LN
Practice Address - Street 2:SUITE 103
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4003
Practice Address - Country:US
Practice Address - Phone:301-464-3590
Practice Address - Fax:301-464-7357
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDLC0148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional