Provider Demographics
NPI:1417333824
Name:MOELLER, MEGAN (LPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MOELLER
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 1:2719 GRAVES DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4536
Mailing Address - Country:US
Mailing Address - Phone:919-330-4367
Mailing Address - Fax:
Practice Address - Street 1:2719 GRAVES DR
Practice Address - Street 2:SUITE 5
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4536
Practice Address - Country:US
Practice Address - Phone:919-330-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health