Provider Demographics
NPI:1952471328
Name:MEREDITH, PATRICIA JANEL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JANEL
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:JANEL
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2440 CENTURY PLACE SE
Mailing Address - Street 2:HICKORY CBOC
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602
Mailing Address - Country:US
Mailing Address - Phone:828-431-5600
Mailing Address - Fax:828-431-5637
Practice Address - Street 1:2440 CENTURY PLACE SE
Practice Address - Street 2:HICKORY VA CBOC
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602
Practice Address - Country:US
Practice Address - Phone:828-431-5600
Practice Address - Fax:828-431-5637
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003107Medicaid