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General NPI Number Information
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NPI Number | 1932775988
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Entity Type | Individual
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Provider Name | DERIK JAMES BERRY CDCA
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Gender | Male
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 113 S 3RD ST
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City | IRONTON
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State | OH
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Zip | 45638-1538
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Country | US
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Telephone | 740-237-4702
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Fax |
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Provider Business Mailing Address
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Address Line | 306 MONROE ST
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City | IRONTON
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State | OH
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Zip | 45638-1844
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Country | US
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Telephone | 740-861-0390
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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 | CDCA.174204
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License Number State | OH
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