Provider Demographics
NPI:1619902871
Name:NEIL, RANSFORD AUTHURBURY II (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:RANSFORD
Middle Name:AUTHURBURY
Last Name:NEIL
Suffix:II
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1373 WESTGATE CENTER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2934
Mailing Address - Country:US
Mailing Address - Phone:336-416-0016
Mailing Address - Fax:336-766-3061
Practice Address - Street 1:1373 WESTGATE CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2934
Practice Address - Country:US
Practice Address - Phone:336-416-0016
Practice Address - Fax:336-766-3061
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102698Medicaid