Doctor Name: | MRS. GINA MARIE MERRITT |
NPI Number: | 1275751323 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | 6801085401 |
Business Practice Address: | 11304 Edgewater Dr Suite D Allendale, MI - 494018499 |
Business Phone Number: | 6168921070 |
Business Fax Number: | |
Mailing Address: | 11304 Edgewater Dr, Suite D ALLENDALE |
State: | MI |
Postal Code: | 494018499 |
Phone Number: | 6168921070 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2007 |
NPI Last Update Date: | 02/03/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 6801085401 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |