Healthcare Provider Details

I. General information

NPI: 1760144802
Provider Name (Legal Business Name): MRS. COLLEEN RENEE MERKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BRADFORD VILLAGE CT
SOUTHERN PINES NC
28387-5451
US

IV. Provider business mailing address

402 HARRIS AVE
RAEFORD NC
28376-3112
US

V. Phone/Fax

Practice location:
  • Phone: 910-684-8750
  • Fax: 910-725-0536
Mailing address:
  • Phone: 910-875-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: