Healthcare Provider Details

I. General information

NPI: 1356154405
Provider Name (Legal Business Name): MEGAN WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E CHURCHVILLE RD STE 300
BEL AIR MD
21014-3485
US

IV. Provider business mailing address

1121 N 5TH AVE
ALTOONA PA
16601-6133
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP18033
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: