1952746885 NPI number — MRS. GWENDOLYN LEVISTER MCNEILL LPC

Table of content: DR. JERRY LYNN NEIDLINGER DDS (NPI 1083724199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952746885 NPI number — MRS. GWENDOLYN LEVISTER MCNEILL LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNEILL
Provider First Name:
GWENDOLYN
Provider Middle Name:
LEVISTER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNEILL
Provider Other First Name:
GWENDOLYN
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1952746885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4608 COVENTRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-4918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-424-3741
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2936 BREEZEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28303-5506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-868-6092
Provider Business Practice Location Address Fax Number:
910-868-8882
Provider Enumeration Date:
05/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  8932 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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