MEDICARE: MEREDITH NISBET LMFTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1901	NC

General Provider Information

NPI Number	:	1285004523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH NISBET LMFTA

Provider Business Mailing Address
First Line	:	5513 BROOK RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-9723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1042 WASHINGTON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27605-1258
Country	:	US
Telephone Number	:	336-430-6694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	03/04/2020

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