=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972929370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P.J. MERCER & ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2014
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9199 REISTERSTOWN RD STE 201B
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-4579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-303-3204
-----------------------------------------------------
Fax | 667-303-3560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 66 PAINTERS MILL RD STE 204
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-3657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-303-3204
-----------------------------------------------------
Fax | 667-303-3560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. PRISCILLA JONES-MERCER
-----------------------------------------------------
Credential | LCSW-C
-----------------------------------------------------
Telephone | 667-303-3204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 07684
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------