Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TH0100X | Health Service |
NPI | 1336792191 |
---|---|
Provider Name | Megan Constance |
First Address | Huntersville, NC 28078-7603 |
Second Address | Charlotte, NC 28208-7201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2019 |
Last Update Date | 22/07/2019 |