Healthcare Provider Details

I. General information

NPI: 1558587055
Provider Name (Legal Business Name): PAMELA J MEEDS PSY D PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S MAIN ST SUITE 207
MOORESVILLE NC
28115-2372
US

IV. Provider business mailing address

116 S MAIN ST SUITE 207
MOORESVILLE NC
28115-2372
US

V. Phone/Fax

Practice location:
  • Phone: 704-662-0124
  • Fax: 704-662-9192
Mailing address:
  • Phone: 704-662-0124
  • Fax: 704-662-9192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0220
License Number StateNC

VIII. Authorized Official

Name: PAMELA JANE MEEDS
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 704-662-0124