Provider Demographics
NPI:1891140737
Name:MCNEILL, TAHIRAH
Entity Type:Individual
Prefix:
First Name:TAHIRAH
Middle Name:
Last Name:MCNEILL
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 1:557 BRAXTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1065
Mailing Address - Country:US
Mailing Address - Phone:910-583-0509
Mailing Address - Fax:
Practice Address - Street 1:557 BRAXTON BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1065
Practice Address - Country:US
Practice Address - Phone:910-583-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0098361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical