Provider Demographics
NPI:1396151155
Name:MERRILL, ANNE (MFT)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S BURGESS TRL
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-0864
Mailing Address - Country:US
Mailing Address - Phone:734-604-4505
Mailing Address - Fax:
Practice Address - Street 1:455 S BURGESS TRL
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-0864
Practice Address - Country:US
Practice Address - Phone:734-604-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006521106H00000X
CA42650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist