Provider Demographics
NPI:1205243987
Name:MEYER, COLLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1650
Mailing Address - Country:US
Mailing Address - Phone:919-960-3775
Mailing Address - Fax:919-960-3799
Practice Address - Street 1:410 N GREENSBORO ST STE 220
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1870
Practice Address - Country:US
Practice Address - Phone:919-966-9803
Practice Address - Fax:919-966-9825
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0092041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205243987Medicaid