Provider Demographics
NPI:1093222663
Name:MERRITT, MARY HEATHER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HEATHER
Last Name:MERRITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:292 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6120
Mailing Address - Country:US
Mailing Address - Phone:478-227-0069
Mailing Address - Fax:
Practice Address - Street 1:2607 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-0933
Practice Address - Country:US
Practice Address - Phone:478-227-0069
Practice Address - Fax:478-818-1966
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0051451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical