Provider Demographics
NPI:1518224054
Name:MERIDITH, RAYNARD D (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:RAYNARD
Middle Name:D
Last Name:MERIDITH
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20326
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-0326
Mailing Address - Country:US
Mailing Address - Phone:248-798-4042
Mailing Address - Fax:
Practice Address - Street 1:21349 REIMANVILLE AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2231
Practice Address - Country:US
Practice Address - Phone:248-798-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional