Basic Information
| Provider Information | |||||||||
| NPI: | 1295789162 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCNEIL | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 284 EXECUTIVE PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251831 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 HIGHWAY 18 SOUTH | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286758478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363724095 | ||||||||
| FaxNumber: | 3363722722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 07/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 30681 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2106163 | 01 | NC | CIGNA PROVIDER ID # | OTHER | 11810 | 01 | NC | UNITED BEHAVIORAL HEALTH | OTHER | C1541 | 01 | NC | MEDCOST PROVIDER ID# | OTHER | 132UC | 01 | NC | BCBS OF NC PROVIDER ID# | OTHER | 89132UC | 05 | NC | MEDICAID | N/A | 01 | NC | MHNET | OTHER | N/A | 01 | NC | CAROLINA BEHAVIORAL HEALT | OTHER |