Provider Demographics
NPI:1629669171
Name:O'NEIL, JACQUELINE ANN
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANN
Last Name:O'NEIL
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 1:285 WEST BIRCH LANE
Mailing Address - Street 2:
Mailing Address - City:ROMMEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757
Mailing Address - Country:US
Mailing Address - Phone:304-359-2380
Mailing Address - Fax:304-359-2393
Practice Address - Street 1:285 WEST BIRCH LANE
Practice Address - Street 2:
Practice Address - City:ROMMEY
Practice Address - State:WV
Practice Address - Zip Code:26757
Practice Address - Country:US
Practice Address - Phone:304-359-2380
Practice Address - Fax:304-359-2393
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV458101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health