Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | A12185 | NC |
NPI | 1003313321 |
---|---|
Provider Name | Melissa O'neill |
First Address | Fuquay Varina, NC 27526-5859 |
Second Address | Holly Springs, NC 27540-8763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 12/04/2018 |