Healthcare Provider Details

I. General information

NPI: 1073278701
Provider Name (Legal Business Name): MEG GROEBER PUTNAM LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 BAMBOO RD
BOONE NC
28607-9673
US

IV. Provider business mailing address

241 GREEN BRIAR RD
BOONE NC
28607-8758
US

V. Phone/Fax

Practice location:
  • Phone: 828-266-9700
  • Fax:
Mailing address:
  • Phone: 864-918-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA14337
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: