Healthcare Provider Details

I. General information

NPI: 1801728399
Provider Name (Legal Business Name): MEREDITH MARION MSW, LCSWA, LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 SAINT GILES ST
RALEIGH NC
27612-7042
US

IV. Provider business mailing address

4472 ROLLER CT
RALEIGH NC
27604-7610
US

V. Phone/Fax

Practice location:
  • Phone: 984-204-1106
  • Fax:
Mailing address:
  • Phone: 336-710-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: