Healthcare Provider Details

I. General information

NPI: 1144180621
Provider Name (Legal Business Name): WHITLEY MEGAN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SHUCKIN ST
HAMPSTEAD NC
28443-8729
US

IV. Provider business mailing address

1222 MAPLE TREE DR APT 108
LELAND NC
28451-9171
US

V. Phone/Fax

Practice location:
  • Phone: 910-599-2230
  • Fax:
Mailing address:
  • Phone: 910-612-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: