Provider Demographics
NPI:1942949409
Name:MCNEAL, BRITTANY SHANESE (EDS)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SHANESE
Last Name:MCNEAL
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CHASTE TREE DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7375
Mailing Address - Country:US
Mailing Address - Phone:214-709-2049
Mailing Address - Fax:
Practice Address - Street 1:220 CHASTE TREE DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7375
Practice Address - Country:US
Practice Address - Phone:214-709-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC294131103TS0200X
WA530413D103TS0200X
TX72173103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool