MEDICARE: MEGHAN DOORTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	9027	SC
2	101YM0800X	Mental Health Counselor	A20208	NC

General Provider Information

NPI Number	:	1164269874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN DOORTY

Provider Business Mailing Address
First Line	:	20123 HENDERSON RD UNIT D
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-5870
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13425 HOOVER CREEK BLVD STE 205
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-0327
Country	:	US
Telephone Number	:	704-502-9397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/10/2024

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Directions to “ MEGHAN DOORTY ” Practice Location

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