1801187810 NPI number — MRS. MEGAN MCCULLOCH INMAN KEITH MSW, LCSW

Table of content: MRS. MEGAN MCCULLOCH INMAN KEITH MSW, LCSW (NPI 1801187810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801187810 NPI number — MRS. MEGAN MCCULLOCH INMAN KEITH MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEITH
Provider First Name:
MEGAN
Provider Middle Name:
MCCULLOCH INMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801187810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 DENIM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERWIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28339-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-897-8930
Provider Business Mailing Address Fax Number:
910-897-8932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7925 PURFOY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FUQUAY VARINA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27526-8937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-557-5840
Provider Business Practice Location Address Fax Number:
919-557-5835
Provider Enumeration Date:
04/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C007891 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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