Provider Demographics
NPI:1730227497
Name:MEADE, GREGORY SHANE (BS PSYCHOLOGY MA COU)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SHANE
Last Name:MEADE
Suffix:
Gender:M
Credentials:BS PSYCHOLOGY MA COU
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:430 INDUSTRIAL DRIVE
Practice Address - Street 2:OPPORTUNITY HOUSE
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277
Practice Address - Country:US
Practice Address - Phone:276-546-4357
Practice Address - Fax:276-546-4640
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor