Provider Demographics
NPI:1598454407
Name:MERRITT, NIKKALUS R (LMSW)
Entity Type:Individual
Prefix:
First Name:NIKKALUS
Middle Name:R
Last Name:MERRITT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 DEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214-3628
Mailing Address - Country:US
Mailing Address - Phone:332-201-9974
Mailing Address - Fax:
Practice Address - Street 1:202 DEWBERRY LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-3628
Practice Address - Country:US
Practice Address - Phone:332-201-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5938G104100000X
ORM14061104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker