Provider Demographics
NPI:1629542352
Name:MERRILL, CHIQUITA MONIQUE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHIQUITA
Middle Name:MONIQUE
Last Name:MERRILL
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 1:3860 SUGAR CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2527
Mailing Address - Country:US
Mailing Address - Phone:757-718-0192
Mailing Address - Fax:
Practice Address - Street 1:7025 HARBOUR VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2761
Practice Address - Country:US
Practice Address - Phone:757-966-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional