Provider Demographics
NPI:1003177395
Name:DIANE O'NEILL LISW LLC
Entity Type:Organization
Organization Name:DIANE O'NEILL LISW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:803-619-9103
Mailing Address - Street 1:852 GOLD HILL RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7976
Mailing Address - Country:US
Mailing Address - Phone:803-619-9103
Mailing Address - Fax:866-585-6452
Practice Address - Street 1:852 GOLD HILL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7976
Practice Address - Country:US
Practice Address - Phone:803-619-9103
Practice Address - Fax:866-585-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC96721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty