Provider Demographics
NPI:1023203783
Name:MERRITT, ROGER W (BE, LPC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:W
Last Name:MERRITT
Suffix:
Gender:M
Credentials:BE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3220
Mailing Address - Country:US
Mailing Address - Phone:919-256-0824
Mailing Address - Fax:
Practice Address - Street 1:725 HIGHLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4206
Practice Address - Country:US
Practice Address - Phone:336-607-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6727101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional