Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 5582 | NC |
N | 103TS0200X | School Psychologist | 1197954 | NC |
NPI | 1336781491 |
---|---|
Provider Name | Dr. John Conor O'neill |
First Address | Durham, NC 27705-4596 |
Second Address | Durham, NC 27705-4597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2019 |
Last Update Date | 04/05/2021 |