Provider Demographics
NPI:1083066955
Name:MCNEIL, BRIYANA
Entity Type:Individual
Prefix:
First Name:BRIYANA
Middle Name:
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 LUPO RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:SC
Mailing Address - Zip Code:29563-5282
Mailing Address - Country:US
Mailing Address - Phone:843-284-9906
Mailing Address - Fax:803-702-1591
Practice Address - Street 1:108 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:SC
Practice Address - Zip Code:29563-3006
Practice Address - Country:US
Practice Address - Phone:843-284-9906
Practice Address - Fax:803-702-1591
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC195101YA0400X
101YM0800X, 251S00000X
SC7302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376241Medicaid
SC376241Medicaid