Doctor Name: | MR. DUSTIN THOMAS MERRILL |
NPI Number: | 1033459540 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW, CADC |
License Number: | 27191 |
Business Practice Address: | 302 E 5th St Sterling, IL - 610813755 |
Business Phone Number: | 8156268760 |
Business Fax Number: | |
Mailing Address: | 302 E 5th St, STERLING |
State: | IL |
Postal Code: | 610813755 |
Phone Number: | 8156268760 |
Fax Number: | |
NPI Enumeration Date: | 02/20/2013 |
NPI Last Update Date: | 02/20/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 27191 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |