Provider Demographics
NPI:1316810799
Name:MEGRATTH, JORDAN THAYER
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:THAYER
Last Name:MEGRATTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 TIMBER PL SE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-7795
Mailing Address - Country:US
Mailing Address - Phone:802-793-2527
Mailing Address - Fax:
Practice Address - Street 1:1132 TIMBER PL SE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-7795
Practice Address - Country:US
Practice Address - Phone:802-793-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31419101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)