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General NPI Number Information
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NPI Number | 1427326834
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Entity Type | Individual
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Provider Name | CLARENCE DEQUAN MERCKERSON L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 4035 US HIGHWAY 231 STE F
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City | WETUMPKA
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State | AL
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Zip | 36093-1224
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Country | US
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Telephone | 334-322-7212
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Fax | 334-478-4983
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Provider Business Mailing Address
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Address Line | 4035 US HIGHWAY 231 STE F
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City | WETUMPKA
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State | AL
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Zip | 36093-1224
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Country | US
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Telephone | 334-322-7212
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Fax | 334-567-6341
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2917
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License Number State | AL
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