Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | A11506 | NC |
NPI | 1003202359 |
---|---|
Provider Name | Erica Merrill |
First Address | Charlotte, NC 28217-6727 |
Second Address | Gastonia, NC 28052-4145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 14/04/2015 |