Healthcare Provider Details

I. General information

NPI: 1467990275
Provider Name (Legal Business Name): MEGAN SIMON KEKICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN E SIMON

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 SAM NEWELL RD STE B-4
MATTHEWS NC
28105-5071
US

IV. Provider business mailing address

1146 SAM NEWELL RD STE B-4
MATTHEWS NC
28105-5071
US

V. Phone/Fax

Practice location:
  • Phone: 704-426-0038
  • Fax:
Mailing address:
  • Phone: 704-426-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-23272
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16697
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: