Provider Demographics
NPI:1952746885
Name:MCNEILL, GWENDOLYN LEVISTER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:LEVISTER
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:GWENDOLYN
Other - Middle Name:L
Other - Last Name:MCNEILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4608 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4918
Mailing Address - Country:US
Mailing Address - Phone:910-424-3741
Mailing Address - Fax:
Practice Address - Street 1:2936 BREEZEWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5506
Practice Address - Country:US
Practice Address - Phone:910-868-6092
Practice Address - Fax:910-868-8882
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional