Provider Demographics
NPI:1497269161
Name:MCNEILL, DALNESHIA DEWANNA
Entity Type:Individual
Prefix:
First Name:DALNESHIA
Middle Name:DEWANNA
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-5502
Mailing Address - Country:US
Mailing Address - Phone:318-955-1346
Mailing Address - Fax:
Practice Address - Street 1:1715 ASHLEY AVE STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-625-7581
Practice Address - Fax:844-317-5579
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2018-08-01
Deactivation Date:2017-11-16
Deactivation Code:
Reactivation Date:2017-12-27
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA810729156Medicaid