Provider Demographics
NPI:1881010460
Name:O'NEAL, MARY AMANDA (LPC-I)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:AMANDA
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 RIVER BLUFF PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7135
Mailing Address - Country:US
Mailing Address - Phone:843-300-0440
Mailing Address - Fax:
Practice Address - Street 1:5421 RIVER BLUFF PKWY
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7135
Practice Address - Country:US
Practice Address - Phone:843-300-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5591101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional