Provider Demographics
NPI:1306869169
Name:BERRYMAN, DEBRA L (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:SHORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0488
Mailing Address - Country:US
Mailing Address - Phone:434-848-4121
Mailing Address - Fax:434-572-4881
Practice Address - Street 1:2087 LAWRENCEVILLE PLANK ROAD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868
Practice Address - Country:US
Practice Address - Phone:434-848-4121
Practice Address - Fax:434-848-4148
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040055421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA466135OtherANTHEM - HALIFAX
VA1700890761Medicaid
VA466131OtherANTHEM - MECK
VA466127OtherANTHEM
VAO81326MOtherSENTARA
VA466131OtherANTHEM - MECK