MEDICARE: THERESHA MCNEILL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C007125	NC

General Provider Information

NPI Number	:	1346576642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESHA MCNEILL LCSW

Provider Business Mailing Address
First Line	:	4565 VERNON FARMS BLVD
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-0130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4565 VERNON FARMS BLVD
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-0130
Country	:	US
Telephone Number	:	336-255-3367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	04/14/2026

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