Individual
TERESA MCNEILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3608 PICKEREL ST, FAYETTEVILLE, NC 28306
(910) 670-0815
Mailing address
3608 PICKEREL ST, FAYETTEVILLE, NC 28306
(910) 670-0815
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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