Provider Demographics
NPI:1407608532
Name:MCNEIL, TAMARA CHANELLE (APC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:CHANELLE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 E JOHNS XING STE 160
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1500
Mailing Address - Country:US
Mailing Address - Phone:470-210-1957
Mailing Address - Fax:
Practice Address - Street 1:6470 E JOHNS XING STE 160
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1500
Practice Address - Country:US
Practice Address - Phone:470-210-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional