Healthcare Provider Details

I. General information

NPI: 1821902719
Provider Name (Legal Business Name): MARY ELIZABETH MCNEILL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CROMWELL DR STE B
GREENVILLE NC
27858-5441
US

IV. Provider business mailing address

710 CROMWELL DR STE B
GREENVILLE NC
27858-5441
US

V. Phone/Fax

Practice location:
  • Phone: 252-606-1123
  • Fax:
Mailing address:
  • Phone: 252-606-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number857
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: