Provider Demographics
NPI:1134724099
Name:BAXTER, MEAGAN R (LCSW)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:R
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19707 US HIGHWAY 280 E APT 1915
Mailing Address - Street 2:
Mailing Address - City:SMITHS STATION
Mailing Address - State:AL
Mailing Address - Zip Code:36877-4063
Mailing Address - Country:US
Mailing Address - Phone:775-501-0234
Mailing Address - Fax:
Practice Address - Street 1:4445 MILLER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4064
Practice Address - Country:US
Practice Address - Phone:775-313-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008051104100000X
GACSW0076101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker