Provider Demographics
NPI:1154896504
Name:PROFESSIONAL CONSULTING & COUNSELING SERVICES
Entity type:Organization
Organization Name:PROFESSIONAL CONSULTING & COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVORIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCASA
Authorized Official - Phone:910-297-4230
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:RIEGELWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28456-0031
Mailing Address - Country:US
Mailing Address - Phone:910-297-4230
Mailing Address - Fax:910-655-0611
Practice Address - Street 1:27056 ANDREW JACKSON HWY E
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-8200
Practice Address - Country:US
Practice Address - Phone:910-297-4230
Practice Address - Fax:910-655-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12771OtherLISW CP
NC21951OtherLICENSED CLINICAL ADDICTION SPECIALIST, ASSOCIATE
NC28389OtherCLINICALLY CERTIFIED SEX OFFENDER TREATMENT SPECIALIST
NCC01149OtherLCSW