Provider Demographics
NPI:1952125270
Name:MERRITT, CHRISTOPHER C (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:MERRITT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 LASA DR APT 211
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-8765
Mailing Address - Country:US
Mailing Address - Phone:770-312-0340
Mailing Address - Fax:
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 202A
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3111
Practice Address - Country:US
Practice Address - Phone:561-903-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical