Provider Demographics
NPI:1841790623
Name:GWALTNEY, MEREDITH S (MA, LMFT-A)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:S
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:MA, LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4059 HOULDSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5786
Mailing Address - Country:US
Mailing Address - Phone:252-573-9188
Mailing Address - Fax:
Practice Address - Street 1:4059 HOULDSWORTH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5786
Practice Address - Country:US
Practice Address - Phone:252-573-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12074A101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional