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NPI Code Detail

MEDICARE: DWIGHT MERRITT LCSW

MEDICARE: DWIGHT MERRITT LCSW
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
1104100000XSocial Worker1825-MAR
21041C0700XClinical Social WorkerLSW0000005724TN

General Provider Information

NPI Number : 1558431684
Entity Type Code : Individual
Provider Name (Legal Business Name) : DWIGHT MERRITT LCSW
Provider Business Mailing Address
First Line : 3385 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-3810
Country : US
Telephone Number : 901-213-9000
Fax Number : 901-791-0891
Provider Business Practice Location Address
First Line : 3385 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-3810
Country : US
Telephone Number : 901-213-9000
Fax Number : 901-791-0891
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 07/01/2014

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Directions to “ DWIGHT MERRITT LCSW” Practice Location

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