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General NPI Number Information
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NPI Number | 1720749161
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Entity Type | Individual
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Provider Name | NEIL R BERRY AADC
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Gender | Male
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 1812 S CRAIG CIR
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City | ROGERS
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State | AR
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Zip | 72758-5608
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Country | US
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Telephone | 479-640-7671
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 S CRAIG CIR
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City | ROGERS
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State | AR
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Zip | 72758
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Country | US
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Telephone | 479-640-7671
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A-307
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License Number State | AR
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