Provider Demographics
NPI:1659114494
Name:MCNIEL, CURTIS JUNIOR JR
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:JUNIOR
Last Name:MCNIEL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3934
Mailing Address - Country:US
Mailing Address - Phone:619-646-4619
Mailing Address - Fax:
Practice Address - Street 1:1709 CANYON RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-3934
Practice Address - Country:US
Practice Address - Phone:619-779-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)