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General NPI Number Information
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NPI Number | 1235774894
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Entity Type | Individual
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Provider Name | REBECCA LOUISE NEILL BS, QDDP, MHRT/C
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 630 HOFSTADTER RD STE 125
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3066
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Country | US
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Telephone | 757-969-8669
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Fax | 757-401-4527
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Provider Business Mailing Address
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Address Line | 630 HOFSTADTER RD STE 125
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3066
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Country | US
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Telephone | 757-969-8669
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Fax | 757-401-4527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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