Healthcare Provider Details

I. General information

NPI: 1760460687
Provider Name (Legal Business Name): MATTHEW A MEIER PSYD, HSP-P, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 BLUE RIDGE RD SUITE 200
RALEIGH NC
27612-4652
US

IV. Provider business mailing address

4112 BLUE RIDGE RD SUITE 200
RALEIGH NC
27612-4652
US

V. Phone/Fax

Practice location:
  • Phone: 919-573-6520
  • Fax: 919-573-6554
Mailing address:
  • Phone: 919-573-6520
  • Fax: 919-573-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2007030010
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3774
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: