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General NPI Number Information
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NPI Number | 1841160587
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Entity Type | Organization
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Legal Business Name | MERIDIAN PSYCHOLOGY PRACTICE PLLC
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 2521 RAEFORD RD STE C-3
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5749
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Country | US
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Telephone | 910-661-3993
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Fax | 844-522-0383
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Provider Business Mailing Address
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Address Line | PO BOX 48081
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City | CUMBERLAND
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State | NC
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Zip | 28331-8081
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Country | US
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Telephone | 910-661-3993
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Fax | 844-522-0383
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Authorized Official
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Title or Position | OWNER/LICENSED PSYCHOLOGIST
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Name | ELLEN MOORE BOOHAR
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Credential | PHD
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Telephone | 910-661-3993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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