Provider Demographics
NPI:1336325026
Name:MEEHAN, TARA LYNN GILLIAM (LPC)
Entity Type:Individual
Prefix:MS
First Name:TARA LYNN
Middle Name:GILLIAM
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6122
Mailing Address - Country:US
Mailing Address - Phone:704-763-0193
Mailing Address - Fax:
Practice Address - Street 1:2605 SHENANDOAH AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6122
Practice Address - Country:US
Practice Address - Phone:704-763-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4130101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)