Provider Demographics
NPI:1073278701
Name:PUTNAM, MEG GROEBER (LCMHCA)
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:GROEBER
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 GREEN BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8758
Mailing Address - Country:US
Mailing Address - Phone:864-918-3228
Mailing Address - Fax:
Practice Address - Street 1:3505 BAMBOO RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-9673
Practice Address - Country:US
Practice Address - Phone:828-266-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty