Provider Demographics
NPI:1669798211
Name:MERROW, MARIANNE L (LCCT)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:L
Last Name:MERROW
Suffix:
Gender:F
Credentials:LCCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 HWY 27/441
Mailing Address - Street 2:SUITE B2
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-4497
Mailing Address - Country:US
Mailing Address - Phone:352-753-4525
Mailing Address - Fax:352-753-4525
Practice Address - Street 1:1011 AVENIDA SONOMA
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6437
Practice Address - Country:US
Practice Address - Phone:352-753-4525
Practice Address - Fax:352-753-4525
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCCT 0284030707101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral