Provider Demographics
NPI:1326525247
Name:MERRYMAN, LADY LOVE BATES (LPC)
Entity Type:Individual
Prefix:
First Name:LADY
Middle Name:LOVE BATES
Last Name:MERRYMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 BAYSWATER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6838
Mailing Address - Country:US
Mailing Address - Phone:912-602-1998
Mailing Address - Fax:
Practice Address - Street 1:3570 CHARLIE SMITH SR HWY
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3500
Practice Address - Country:US
Practice Address - Phone:912-673-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional