Provider Demographics
NPI:1508050089
Name:FENCER, MEGHAN MARIE (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:MARIE
Last Name:FENCER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 ATLANTIC BLVD # 208
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-3313
Mailing Address - Country:US
Mailing Address - Phone:904-651-0237
Mailing Address - Fax:
Practice Address - Street 1:4040 WOODCOCK DR
Practice Address - Street 2:MIDTOWN CENTRE BUILDING 2200 SUITE 232
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2720
Practice Address - Country:US
Practice Address - Phone:904-651-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health