Healthcare Provider Details

I. General information

NPI: 1083066955
Provider Name (Legal Business Name): BRIYANA MCNEIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N WALNUT ST
LAKE VIEW SC
29563-3006
US

IV. Provider business mailing address

691 LUPO RD
LAKE VIEW SC
29563-5282
US

V. Phone/Fax

Practice location:
  • Phone: 843-284-9906
  • Fax: 803-702-1591
Mailing address:
  • Phone: 843-284-9906
  • Fax: 803-702-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number195
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7302
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: