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General NPI Number Information
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NPI Number | 1740536937
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Entity Type | Individual
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Provider Name | MICHELLE M MEERTINS PH.D., LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 4831 EAGLES RIDGE LOOP
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City | LITHONIA
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State | GA
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Zip | 30038-3533
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Country | US
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Telephone | 770-981-0024
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Fax | 770-981-0024
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Provider Business Mailing Address
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Address Line | 4831 EAGLES RIDGE LOOP
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City | LITHONIA
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State | GA
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Zip | 30038-3533
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Country | US
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Telephone | 770-981-0024
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Fax | 770-981-0024
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW002341
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License Number State | GA
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