MEDICARE: MRS. STEPHANIE WISE MERRICK M. ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor	PPS-359302	VA

General Provider Information

NPI Number	:	1194569442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE WISE MERRICK M. ED

Provider Business Mailing Address
First Line	:	9450 ATLEE STATION RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2600
Country	:	US
Telephone Number	:	804-723-2160
Fax Number	:

Provider Business Practice Location Address
First Line	:	9450 ATLEE STATION RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2600
Country	:	US
Telephone Number	:	804-723-2162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/21/2024

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