Provider Demographics
NPI:1750161451
Name:KNOWLES, MEAGAN MILLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:MILLEN
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3705
Mailing Address - Country:US
Mailing Address - Phone:919-961-0061
Mailing Address - Fax:
Practice Address - Street 1:3100 DURALEIGH RD STE 210
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8104
Practice Address - Country:US
Practice Address - Phone:919-961-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4838103TS0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool