Provider Demographics
NPI:1619237278
Name:MERCER, CARRIE MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:MERCER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KWAN PLAZA
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1899
Mailing Address - Country:US
Mailing Address - Phone:573-438-0751
Mailing Address - Fax:
Practice Address - Street 1:1 KWAN PLZ
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1435
Practice Address - Country:US
Practice Address - Phone:573-438-5451
Practice Address - Fax:573-438-0007
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120140201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical