MEDICARE: MS. SHANTREAS NICOLE O'NEIL 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	CSW005293	GA

General Provider Information

NPI Number	:	1639685332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANTREAS NICOLE O'NEIL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 7716
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30065-1716
Country	:	US
Telephone Number	:	678-851-5104
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 PHOENIX BLVD STE 128-12
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5593
Country	:	US
Telephone Number	:	678-851-5104
Fax Number	:

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

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	05/07/2024

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