Provider Demographics
NPI:1629494976
Name:MERRITT, JEREMY CHAD (LPC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:CHAD
Last Name:MERRITT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N CORNERS PKWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2078
Mailing Address - Country:US
Mailing Address - Phone:678-341-3840
Mailing Address - Fax:
Practice Address - Street 1:125 N CORNERS PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2078
Practice Address - Country:US
Practice Address - Phone:678-341-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional