=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811664055
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEAGAN ARNOLD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2021
-----------------------------------------------------
Last Update Date | 08/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2008 BREMO RD STE 111
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23226-2443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-918-1115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18000 GOLDEN BEAR TRCE APT 204
-----------------------------------------------------
City | MOSELEY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23120-1880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-495-3010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 0704014209
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------