Provider Demographics
NPI:1548972292
Name:MCNEAL, LISA LATREASE (BSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LATREASE
Last Name:MCNEAL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30715 SHIAWASSEE RD APT 64
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-4366
Mailing Address - Country:US
Mailing Address - Phone:248-719-9601
Mailing Address - Fax:
Practice Address - Street 1:2941 S GULLEY RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3160
Practice Address - Country:US
Practice Address - Phone:313-278-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852-093213104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker