Provider Demographics
NPI:1679900187
Name:MCNEILL, JENINNE (PHD, LCP)
Entity type:Individual
Prefix:DR
First Name:JENINNE
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 NEWTOWN RD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4802
Mailing Address - Country:US
Mailing Address - Phone:757-222-0814
Mailing Address - Fax:757-222-0813
Practice Address - Street 1:6330 NEWTOWN RD
Practice Address - Street 2:SUITE 525
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4802
Practice Address - Country:US
Practice Address - Phone:757-222-0814
Practice Address - Fax:757-222-0813
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical