Provider Demographics
NPI:1306431853
Name:MCNEIL, LEWIS EDWARD (NCCPSS)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:EDWARD
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:NCCPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179A PONDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-7205
Mailing Address - Country:US
Mailing Address - Phone:336-927-0792
Mailing Address - Fax:
Practice Address - Street 1:179A PONDVIEW DR
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-7205
Practice Address - Country:US
Practice Address - Phone:336-927-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175T00000X
NCV2019-6712-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist