Provider Demographics
NPI:1194569442
Name:MERRICK, STEPHANIE WISE (M ED)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:WISE
Last Name:MERRICK
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 ATLEE STATION RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2600
Mailing Address - Country:US
Mailing Address - Phone:804-723-2160
Mailing Address - Fax:
Practice Address - Street 1:9450 ATLEE STATION RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2600
Practice Address - Country:US
Practice Address - Phone:804-723-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-359302101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool