Provider Demographics
NPI:1336381235
Name:BROWN-MEADERS, MIRANDA DENISE (LPA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:DENISE
Last Name:BROWN-MEADERS
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 OZARK CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9809
Mailing Address - Country:US
Mailing Address - Phone:803-325-5491
Mailing Address - Fax:
Practice Address - Street 1:13735 STEELE CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6841
Practice Address - Country:US
Practice Address - Phone:803-325-5491
Practice Address - Fax:800-487-7401
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4017103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107692Medicaid