Provider Demographics
NPI:1831864529
Name:MERRITT, ANGELA DAWN
Entity type:Individual
Prefix:PROF
First Name:ANGELA
Middle Name:DAWN
Last Name:MERRITT
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 1:504 HOLLYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-1082
Mailing Address - Country:US
Mailing Address - Phone:304-299-2522
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2176
Practice Address - Country:US
Practice Address - Phone:304-893-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator