Provider Demographics
NPI:1437165438
Name:MERRITT, JUDI HANI (LCSW, NBCCH)
Entity Type:Individual
Prefix:MS
First Name:JUDI
Middle Name:HANI
Last Name:MERRITT
Suffix:
Gender:F
Credentials:LCSW, NBCCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 TILLOTSON RD
Mailing Address - Street 2:
Mailing Address - City:PINNACLE
Mailing Address - State:NC
Mailing Address - Zip Code:27043-8281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1821 TILLOTSON RD
Practice Address - Street 2:
Practice Address - City:PINNACLE
Practice Address - State:NC
Practice Address - Zip Code:27043-8281
Practice Address - Country:US
Practice Address - Phone:336-351-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0013131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1152FOtherBCBS ID #
NC6002290Medicaid
NC2869304BMedicare ID - Type UnspecifiedMEDICARE ID #