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General NPI Number Information
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NPI Number | 1215307558
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Entity Type | Organization
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Legal Business Name | MCNEILL THERAPY & TESTING
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 05/07/2016
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Provider Practice Location Address
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Address Line | 6330 NEWTOWN RD SUITE 525
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City | NORFOLK
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State | VA
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Zip | 23502-4802
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Country | US
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Telephone | 757-222-0814
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Fax | 757-222-0813
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Provider Business Mailing Address
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Address Line | 6330 NEWTOWN RD SUITE 525
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City | NORFOLK
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State | VA
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Zip | 23502-4802
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Country | US
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Telephone | 757-222-0814
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Fax | 757-222-0813
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. JENINNE MCNEILL
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Credential | PHD
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Telephone | 757-222-0814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004873
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License Number State | VA
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