Healthcare Provider Details

I. General information

NPI: 1124757638
Provider Name (Legal Business Name): MEAGHAN BRACKIN LCMHC-A, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 SAINT GILES ST
RALEIGH NC
27612-7042
US

IV. Provider business mailing address

441 S DILLARD ST APT 152
DURHAM NC
27701-4948
US

V. Phone/Fax

Practice location:
  • Phone: 919-893-4465
  • Fax:
Mailing address:
  • Phone: 630-730-9307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA17620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: