Provider Demographics
NPI:1851596605
Name:MCNEILL, JEWEL VANESSA (LPC)
Entity Type:Individual
Prefix:MS
First Name:JEWEL
Middle Name:VANESSA
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 CASTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8518
Mailing Address - Country:US
Mailing Address - Phone:910-624-6262
Mailing Address - Fax:
Practice Address - Street 1:403 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2911
Practice Address - Country:US
Practice Address - Phone:910-624-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102624Medicaid