Provider Demographics
NPI:1306474028
Name:SMITH-MERRY, NICOLE LYNN (LPC,NCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:SMITH-MERRY
Suffix:
Gender:F
Credentials:LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 MEHRING RD
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-9158
Mailing Address - Country:US
Mailing Address - Phone:443-703-8888
Mailing Address - Fax:
Practice Address - Street 1:23 BALTIMORE ST STE 102
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2306
Practice Address - Country:US
Practice Address - Phone:717-549-2533
Practice Address - Fax:717-549-2534
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional