Provider Demographics
NPI:1639539893
Name:MERAKI CENTER FOR WELLNESS, PLLC
Entity type:Organization
Organization Name:MERAKI CENTER FOR WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:WOODGEARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, LCSWA, CSAC
Authorized Official - Phone:336-804-2054
Mailing Address - Street 1:313 TRINDALE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-3800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 TRINDALE RD
Practice Address - Street 2:SUITE E
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3800
Practice Address - Country:US
Practice Address - Phone:336-899-7945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51178251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health