Provider Demographics
NPI:1205311859
Name:MCNEILL, FELICICIA
Entity type:Individual
Prefix:MS
First Name:FELICICIA
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29155 NORTHWESTERN HWY #780
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1011
Mailing Address - Country:US
Mailing Address - Phone:313-208-1656
Mailing Address - Fax:
Practice Address - Street 1:15900 W. 10 MILE ROAD
Practice Address - Street 2:FL 2, STE. 211
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2036
Practice Address - Country:US
Practice Address - Phone:248-957-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MI6401016810101Y00000X, 101YS0200X
MI6401019505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool