Healthcare Provider Details

I. General information

NPI: 1033621610
Provider Name (Legal Business Name): HEATHER BERRY COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 WOFFORD BLVD UNIT A
WOFFORD HEIGHTS CA
93285-9800
US

IV. Provider business mailing address

PO BOX 363
WOFFORD HEIGHTS CA
93285-0363
US

V. Phone/Fax

Practice location:
  • Phone: 760-417-2392
  • Fax: 760-417-2392
Mailing address:
  • Phone: 760-417-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18232
License Number StateCA

VIII. Authorized Official

Name: HEATHER SANDRA BERRY
Title or Position: OWNER
Credential: LCSW
Phone: 760-417-2392