Provider Demographics
NPI:1104326073
Name:HATHORN, MERIDITH MERCER (LCMHC)
Entity type:Individual
Prefix:
First Name:MERIDITH
Middle Name:MERCER
Last Name:HATHORN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PHEASANT WALK WAY
Mailing Address - Street 2:
Mailing Address - City:VILAS
Mailing Address - State:NC
Mailing Address - Zip Code:28692-8371
Mailing Address - Country:US
Mailing Address - Phone:828-719-6868
Mailing Address - Fax:
Practice Address - Street 1:184 N WATER ST STE 8
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-3556
Practice Address - Country:US
Practice Address - Phone:828-719-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional