Provider Demographics
NPI:1083327704
Name:O'NEAL, CONNIE DAVIS (MS)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:DAVIS
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-2557
Mailing Address - Country:US
Mailing Address - Phone:423-231-8496
Mailing Address - Fax:
Practice Address - Street 1:1135 W 3RD NORTH ST STE A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3889
Practice Address - Country:US
Practice Address - Phone:423-587-9339
Practice Address - Fax:423-587-3439
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional