Provider Demographics
NPI:1821320086
Name:MERIDIAN COUNSELING GROUP PLLC
Entity Type:Organization
Organization Name:MERIDIAN COUNSELING GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:TARA LYNN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-763-0193
Mailing Address - Street 1:811 CENTRAL AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2032
Mailing Address - Country:US
Mailing Address - Phone:704-763-0193
Mailing Address - Fax:704-612-8024
Practice Address - Street 1:811 CENTRAL AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2032
Practice Address - Country:US
Practice Address - Phone:704-763-0193
Practice Address - Fax:704-612-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty