Healthcare Provider Details

I. General information

NPI: 1114889011
Provider Name (Legal Business Name): MEAGAN NICOLE DIRVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 E MILLBROOK RD STE 101
RALEIGH NC
27604-1746
US

IV. Provider business mailing address

101 LAUGHING OAK LN APT 106
WILMINGTON NC
28401-6276
US

V. Phone/Fax

Practice location:
  • Phone: 919-307-8165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22300
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: