Healthcare Provider Details

I. General information

NPI: 1326236779
Provider Name (Legal Business Name): CORINNE MEADER LPC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GATEWAY BLVD STE 207
MOORESVILLE NC
28117-5596
US

IV. Provider business mailing address

146 BRANTLEY PLACE DR
MOORESVILLE NC
28117-6859
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-1175
  • Fax: 704-664-1193
Mailing address:
  • Phone: 740-953-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6005932
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6733
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: