Provider Demographics
NPI:1396798674
Name:O'NEAL, THOMAS HOLLAND (MA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HOLLAND
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W CARSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4024
Mailing Address - Country:US
Mailing Address - Phone:704-375-9025
Mailing Address - Fax:704-375-0054
Practice Address - Street 1:328 W CARSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4024
Practice Address - Country:US
Practice Address - Phone:704-375-9025
Practice Address - Fax:704-375-0054
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC64165OtherBLUE CROSS NUMBER