MEDICARE: TASHUA BERRY DENNIS LICSW, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3488	AL
2	1041C0700X	Clinical Social Worker	5088C	AL

General Provider Information

NPI Number	:	1063861003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHUA BERRY DENNIS LICSW, LPC

Provider Business Mailing Address
First Line	:	308 WILSON DR SW
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-2752
Country	:	US
Telephone Number	:	256-225-8769
Fax Number	:	256-467-8086

Provider Business Practice Location Address
First Line	:	1316 NOBLE ST
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36201-4643
Country	:	US
Telephone Number	:	256-236-0221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	01/04/2024

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