Provider Demographics
NPI:1558108308
Name:MERRELL, MARY ROGERS (MS, NCC)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ROGERS
Last Name:MERRELL
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2150
Mailing Address - Country:US
Mailing Address - Phone:601-573-9703
Mailing Address - Fax:
Practice Address - Street 1:4045 ORCHARD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4902
Practice Address - Country:US
Practice Address - Phone:770-293-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health