Provider Demographics
NPI:1922899038
Name:NEALY, TABRICEIA BRENAE (MS)
Entity type:Individual
Prefix:
First Name:TABRICEIA
Middle Name:BRENAE
Last Name:NEALY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5298
Mailing Address - Country:US
Mailing Address - Phone:706-910-2335
Mailing Address - Fax:
Practice Address - Street 1:519 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8202
Practice Address - Country:US
Practice Address - Phone:706-910-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health