Provider Demographics
NPI:1215307558
Name:MCNEILL THERAPY & TESTING
Entity type:Organization
Organization Name:MCNEILL THERAPY & TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-222-0814
Mailing Address - Street 1:6330 NEWTOWN RD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4802
Mailing Address - Country:US
Mailing Address - Phone:757-222-0814
Mailing Address - Fax:757-222-0813
Practice Address - Street 1:6330 NEWTOWN RD
Practice Address - Street 2:SUITE 525
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4802
Practice Address - Country:US
Practice Address - Phone:757-222-0814
Practice Address - Fax:757-222-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ45337F677Medicare PIN