Provider Demographics
NPI:1376978353
Name:O'NEILL, JOHN CHARLES (LICSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S HOWARD ST
Mailing Address - Street 2:SUITE 321
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3821
Mailing Address - Country:US
Mailing Address - Phone:509-838-4128
Mailing Address - Fax:509-838-4816
Practice Address - Street 1:7 S HOWARD ST
Practice Address - Street 2:SUITE 321
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3821
Practice Address - Country:US
Practice Address - Phone:509-838-4128
Practice Address - Fax:509-838-4816
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000077701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical