Provider Demographics
NPI:1518694819
Name:MCNEIL, CHARLES J (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 HENDERSON WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6638
Mailing Address - Country:US
Mailing Address - Phone:858-200-6896
Mailing Address - Fax:
Practice Address - Street 1:621 4TH ST STE 3
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4151
Practice Address - Country:US
Practice Address - Phone:916-546-9629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical