Provider Demographics
NPI:1932722105
Name:VAN RENSBURG, MEREDITH (LCMHC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:VAN RENSBURG
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 CUTLER ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:174 MINE LAKE CT STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6417
Practice Address - Country:US
Practice Address - Phone:984-500-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-06-11
Deactivation Date:2020-05-22
Deactivation Code:
Reactivation Date:2020-06-11
Provider Licenses
StateLicense IDTaxonomies
NC13313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional