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General NPI Number Information
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NPI Number | 1063861003
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Entity Type | Individual
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Provider Name | TASHUA BERRY DENNIS LICSW, LPC
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Gender | Female
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 1316 NOBLE ST
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City | ANNISTON
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State | AL
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Zip | 36201-4643
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Country | US
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Telephone | 256-236-0221
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Fax |
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Provider Business Mailing Address
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Address Line | 308 WILSON DR SW
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City | JACKSONVILLE
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State | AL
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Zip | 36265-2752
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Country | US
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Telephone | 256-225-8769
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Fax | 256-467-8086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3488
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5088C
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License Number State | AL
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