MEDICARE: SHERRITA LENETT MERCER

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor	C.1800968	OH

General Provider Information

NPI Number	:	1508335720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRITA LENETT MERCER

Provider Business Mailing Address
First Line	:	2117 BEECHMONT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-5414
Country	:	US
Telephone Number	:	513-813-6269
Fax Number	:

Provider Business Practice Location Address
First Line	:	2117 BEECHMONT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-5414
Country	:	US
Telephone Number	:	513-813-6269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	09/07/2022

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