Provider Demographics
NPI:1689891053
Name:MERRICK, CAROLYN J (MA/CAC III)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:J
Last Name:MERRICK
Suffix:
Gender:F
Credentials:MA/CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E. MIAMI ST.
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402
Mailing Address - Country:US
Mailing Address - Phone:970-497-8948
Mailing Address - Fax:970-249-2955
Practice Address - Street 1:650 E. MIAMI ST.
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81402
Practice Address - Country:US
Practice Address - Phone:619-587-9162
Practice Address - Fax:970-249-2955
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3601101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)