Provider Demographics
NPI:1689263378
Name:BOURQUE, MEAGHAN DANIELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MEAGHAN
Middle Name:DANIELLE
Last Name:BOURQUE
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 1:3250 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35023-5784
Mailing Address - Country:US
Mailing Address - Phone:850-382-5525
Mailing Address - Fax:
Practice Address - Street 1:3250 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35023-5784
Practice Address - Country:US
Practice Address - Phone:850-382-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health