Provider Demographics
NPI:1275092363
Name:PROCTOR, MEGAN ALYSSA (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALYSSA
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 UNIVERSITY DR APT 14B
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3473
Mailing Address - Country:US
Mailing Address - Phone:336-687-5663
Mailing Address - Fax:
Practice Address - Street 1:400 CRUTCHFIELD ST STE D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2771
Practice Address - Country:US
Practice Address - Phone:919-251-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health