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General NPI Number Information
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NPI Number | 1699422527
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Entity Type | Organization
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Legal Business Name | CRYSTAL H BERRY & CANDACE S BERRY
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 548 OLLIE RD
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City | PELION
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State | SC
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Zip | 29123-9400
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Country | US
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Telephone | 803-580-0298
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Fax |
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Provider Business Mailing Address
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Address Line | 548 OLLIE RD
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City | PELION
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State | SC
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Zip | 29123-9400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | CRYSTAL BERRY
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Credential | MA, NCC
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Telephone | 803-580-0298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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