Healthcare Provider Details

I. General information

NPI: 1447823000
Provider Name (Legal Business Name): ANNIE BRITT BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 PAT THOMAS PKWY
QUINCY FL
32351-8642
US

IV. Provider business mailing address

2127 PAT THOMAS PKWY
QUINCY FL
32351-8642
US

V. Phone/Fax

Practice location:
  • Phone: 850-627-0251
  • Fax: 850-627-0252
Mailing address:
  • Phone: 850-627-0251
  • Fax: 850-627-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLIC-1047147
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1047147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: