Basic Information
Provider Information
NPI: 1255881959
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDERSON
FirstName: MEGAN
MiddleName: BLAIR
NamePrefix: MS.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8879
Address2:  
City: ASHEVILLE
State: NC
PostalCode: 288148879
CountryCode: US
TelephoneNumber: 3369787204
FaxNumber: 8663385921
Practice Location
Address1: 8025 N POINT BLVD STE 209
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 27106
CountryCode: US
TelephoneNumber: 8283297264
FaxNumber: 8663385921
Other Information
ProviderEnumerationDate: 10/06/2016
LastUpdateDate: 07/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X12227NCY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


Home