Provider Demographics
NPI:1518471242
Name:O'NEAL, JACQUELINE RENEE (LPCA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RENEE
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:BADIN
Mailing Address - State:NC
Mailing Address - Zip Code:28009-0081
Mailing Address - Country:US
Mailing Address - Phone:704-463-0300
Mailing Address - Fax:
Practice Address - Street 1:32 HICKORY STREET
Practice Address - Street 2:
Practice Address - City:BADIN
Practice Address - State:NC
Practice Address - Zip Code:28009
Practice Address - Country:US
Practice Address - Phone:704-463-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional