Provider Demographics
NPI:1376130633
Name:MCNEILL, JEANNETTE MICHELLE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MICHELLE
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 OXBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3035
Mailing Address - Country:US
Mailing Address - Phone:301-905-8316
Mailing Address - Fax:
Practice Address - Street 1:9605 OXBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3035
Practice Address - Country:US
Practice Address - Phone:301-905-8316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical