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NPI Code Detail

MEDICARE: NINA JOHANNA BERKELEY LPC

MEDICARE: NINA JOHANNA BERKELEY 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
1101YM0800XMental Health CounselorLPC006093GA
2101YP2500XProfessional Counselor2681WV

General Provider Information

NPI Number : 1154629913
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINA JOHANNA BERKELEY LPC
Provider Business Mailing Address
First Line : 1005 WHITE WILLOW WAY
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-6119
Country : US
Telephone Number : 304-460-5123
Fax Number : 800-734-8498
Provider Business Practice Location Address
First Line : 601 20TH ST
Second Line :
City : HUNTINGTON
State : WV
Zip : 25703-1512
Country : US
Telephone Number : 304-429-1088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2011
Last Update Date : 06/11/2024

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Directions to “ NINA JOHANNA BERKELEY LPC” Practice Location

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