Provider Demographics
NPI:1487793147
Name:MERRITT DOHERTY, CAROLE LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:LYNN
Last Name:MERRITT DOHERTY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-8622
Mailing Address - Country:US
Mailing Address - Phone:231-624-0091
Mailing Address - Fax:
Practice Address - Street 1:509 N BIRCH ST
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-8414
Practice Address - Country:US
Practice Address - Phone:231-258-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010571671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical