Provider Demographics
NPI:1053784314
Name:O'NEAL, SAMMIE III (MA, CDC1)
Entity type:Individual
Prefix:MR
First Name:SAMMIE
Middle Name:
Last Name:O'NEAL
Suffix:III
Gender:M
Credentials:MA, CDC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12518 CRESTED BUTTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-2745
Mailing Address - Country:US
Mailing Address - Phone:907-406-3033
Mailing Address - Fax:
Practice Address - Street 1:12518 CRESTED BUTTE DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7654
Practice Address - Country:US
Practice Address - Phone:907-406-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health