Provider Demographics
NPI:1689200271
Name:PALMER, IDA MCNEAR (CADCII)
Entity type:Individual
Prefix:MS
First Name:IDA
Middle Name:MCNEAR
Last Name:PALMER
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4836
Mailing Address - Country:US
Mailing Address - Phone:912-506-6910
Mailing Address - Fax:
Practice Address - Street 1:501 GLOUCESTER ST STE 207
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-7002
Practice Address - Country:US
Practice Address - Phone:912-506-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1415101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)