Provider Demographics
NPI:1831842558
Name:NEILL, JILLIAN LEIGH (PHD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEIGH
Last Name:NEILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:LEIGH
Other - Last Name:BARTELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2029 WILLIAMSBURG MANOR CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5712
Mailing Address - Country:US
Mailing Address - Phone:919-271-3067
Mailing Address - Fax:
Practice Address - Street 1:2029 WILLIAMSBURG MANOR CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5712
Practice Address - Country:US
Practice Address - Phone:919-271-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical