Provider Demographics
NPI:1215970017
Name:BERREY, MARY RUTH (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:RUTH
Last Name:BERREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17450 INTERSTATE LN
Mailing Address - Street 2:PO BOX 97
Mailing Address - City:DEWITT
Mailing Address - State:VA
Mailing Address - Zip Code:23840-3047
Mailing Address - Country:US
Mailing Address - Phone:804-469-4924
Mailing Address - Fax:
Practice Address - Street 1:20 W BANK ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3279
Practice Address - Country:US
Practice Address - Phone:804-862-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710001171101YP2500X
VA0701002479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA204316OtherANTHEM
VA087505OtherSENTARA