Provider Demographics
NPI:1508949371
Name:MEREDITH, CAROLE (MFT)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 SECOND ST
Mailing Address - Street 2:#270
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5008
Mailing Address - Country:US
Mailing Address - Phone:858-646-9579
Mailing Address - Fax:760-431-6334
Practice Address - Street 1:3252 HOLIDAY COURT
Practice Address - Street 2:SUITE 110
Practice Address - City:LO JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1807
Practice Address - Country:US
Practice Address - Phone:858-646-9579
Practice Address - Fax:877-566-5310
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29431106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist