MEDICARE: MERIDIAN COUNSELING GROUP PLLC

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	101YM0800X	Mental Health Counselor	4130	NC

General Provider Information

NPI Number	:	1821320086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN COUNSELING GROUP PLLC

Provider Business Mailing Address
First Line	:	811 CENTRAL AVE
Second Line	:	SUITE 7
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2032
Country	:	US
Telephone Number	:	704-763-0193
Fax Number	:	704-612-8024

Provider Business Practice Location Address
First Line	:	811 CENTRAL AVE
Second Line	:	SUITE 7
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2032
Country	:	US
Telephone Number	:	704-763-0193
Fax Number	:	704-612-8024

Authorized Official
Title or Position	:	OWNER/CLINICAL CONSULTANT
Name	:	TARA LYNN G MEEHAN
Credential	:
Telephone Number	:	704-763-0193

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	03/11/2011

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