Provider Demographics
NPI:1295068179
Name:CONNELL, MEGAN ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ANN
Last Name:CONNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 BRIXHAM HILL AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4785
Mailing Address - Country:US
Mailing Address - Phone:704-970-4791
Mailing Address - Fax:704-970-4794
Practice Address - Street 1:15720 BRIXHAM HILL AVE STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4785
Practice Address - Country:US
Practice Address - Phone:704-970-4791
Practice Address - Fax:704-940-4794
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60181879103TC0700X
NC4050103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical