Provider Demographics
NPI:1841160587
Name:MERIDIAN PSYCHOLOGY PRACTICE PLLC
Entity type:Organization
Organization Name:MERIDIAN PSYCHOLOGY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:BOOHAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-661-3993
Mailing Address - Street 1:PO BOX 48081
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28331-8081
Mailing Address - Country:US
Mailing Address - Phone:910-661-3993
Mailing Address - Fax:844-522-0383
Practice Address - Street 1:2521 RAEFORD RD STE C-3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5749
Practice Address - Country:US
Practice Address - Phone:910-661-3993
Practice Address - Fax:844-522-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health