Provider Demographics
NPI:1972666402
Name:NEILL, MERRILY
Entity Type:Individual
Prefix:MS
First Name:MERRILY
Middle Name:
Last Name:NEILL
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 1:700 BOLIN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-4106
Mailing Address - Country:US
Mailing Address - Phone:919-942-1200
Mailing Address - Fax:919-967-9904
Practice Address - Street 1:700 BOLIN CREEK DR
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-4106
Practice Address - Country:US
Practice Address - Phone:919-942-1200
Practice Address - Fax:919-967-9904
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175000000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC62060OtherBCBS PROVIDER NUMBER
NC1750000000OtherSTATE CSSW LICENSE #
NC1750000000OtherSTATE CSSW LICENSE #