Provider Demographics
NPI:1992735401
Name:MEARES, GLORIA J (PHD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:J
Last Name:MEARES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 WESTCHASE BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3938
Mailing Address - Country:US
Mailing Address - Phone:919-828-7244
Mailing Address - Fax:
Practice Address - Street 1:4020 WESTCHASE BLVD
Practice Address - Street 2:STE 130
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3938
Practice Address - Country:US
Practice Address - Phone:919-828-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1173103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7124763OtherMAMSI
A3001833OtherVALUE BEL
NC2814285Medicare ID - Type Unspecified
A3001833OtherVALUE BEL