Provider Demographics
NPI:1619011178
Name:MCNIEL, CRYSTAL SMITH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:SMITH
Last Name:MCNIEL
Suffix:
Gender:F
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:PO BOX 680427
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0008
Mailing Address - Country:US
Mailing Address - Phone:704-641-4515
Mailing Address - Fax:866-586-7685
Practice Address - Street 1:19824 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4046
Practice Address - Country:US
Practice Address - Phone:704-641-4515
Practice Address - Fax:866-586-7685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106127Medicaid