Provider Demographics
NPI:1154839793
Name:RICHARDSON, MEGHAN ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:RICHARDSON
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 1:1404 CANAL DR APT 24
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-5957
Mailing Address - Country:US
Mailing Address - Phone:252-714-8185
Mailing Address - Fax:
Practice Address - Street 1:1404 CANAL DR APT 24
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-5957
Practice Address - Country:US
Practice Address - Phone:252-714-8185
Practice Address - Fax:252-714-8185
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional