Provider Demographics
NPI:1235422569
Name:MEEKS, IAN DOMINIC (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:DOMINIC
Last Name:MEEKS
Suffix:
Gender:M
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BRANNER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3244
Mailing Address - Country:US
Mailing Address - Phone:828-232-8934
Mailing Address - Fax:
Practice Address - Street 1:166 BRANNER AVE STE B
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3244
Practice Address - Country:US
Practice Address - Phone:828-232-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6115109Medicaid