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General NPI Number Information
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NPI Number | 1154859957
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Entity Type | Individual
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Provider Name | MEGAN E. LAVERY LPC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 102 LAKESHORE DR STE B
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City | SAINT MARYS
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State | GA
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Zip | 31558-3875
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Country | US
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Telephone | 912-882-3800
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Fax | 912-882-3303
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Provider Business Mailing Address
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Address Line | 2762 FOREST RIDGE DR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-0411
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Country | US
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Telephone | 270-791-6656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT011078
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC011638
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License Number State | GA
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