Provider Demographics
NPI:1881224954
Name:MERRITTS, KIMBERLY LYNETTE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNETTE
Last Name:MERRITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 OLDE MILL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6475
Mailing Address - Country:US
Mailing Address - Phone:843-597-6693
Mailing Address - Fax:
Practice Address - Street 1:1550 N WILLISTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-8744
Practice Address - Country:US
Practice Address - Phone:843-597-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health