Provider Demographics
NPI:1801187810
Name:KEITH, MEGAN MCCULLOCH INMAN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MCCULLOCH INMAN
Last Name:KEITH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DENIM DR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2204
Mailing Address - Country:US
Mailing Address - Phone:910-897-8930
Mailing Address - Fax:910-897-8932
Practice Address - Street 1:7925 PURFOY RD
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-8937
Practice Address - Country:US
Practice Address - Phone:919-557-5840
Practice Address - Fax:919-557-5835
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0078911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical