Provider Demographics
NPI:1497158273
Name:O'NEAL, MONICA (NCC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4680 BROWNSBORO RD STE D
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3428
Mailing Address - Country:US
Mailing Address - Phone:336-287-5970
Mailing Address - Fax:
Practice Address - Street 1:4680 BROWNSBORO RD STE D
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3428
Practice Address - Country:US
Practice Address - Phone:336-287-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC260610547Medicaid