Healthcare Provider Details

I. General information

NPI: 1659340248
Provider Name (Legal Business Name): WILLIAM PHILIP BERRY L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MCDOWELL AVE NW
ROANOKE VA
24016-1225
US

IV. Provider business mailing address

301 ELM AVE SW
ROANOKE VA
24016-4001
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-3007
  • Fax: 540-266-9204
Mailing address:
  • Phone: 540-354-9841
  • Fax: 540-527-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701101691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: