Provider Demographics
NPI:1619054632
Name:BERNARD, MELDRINA A
Entity Type:Individual
Prefix:
First Name:MELDRINA
Middle Name:A
Last Name:BERNARD
Suffix:
Gender:F
Credentials:
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 530
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-0530
Mailing Address - Country:US
Mailing Address - Phone:919-691-2914
Mailing Address - Fax:
Practice Address - Street 1:1556 HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-693-5943
Practice Address - Fax:919-529-1839
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical