Provider Demographics
NPI:1679898662
Name:O'NEIL, MIATA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIATA
Middle Name:
Last Name:O'NEIL
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 1:542 WOODSTONE RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5900
Mailing Address - Country:US
Mailing Address - Phone:678-485-8772
Mailing Address - Fax:
Practice Address - Street 1:165 BURKE ST STE 109
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3464
Practice Address - Country:US
Practice Address - Phone:770-389-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0019941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical