Provider Demographics
NPI:1386785707
Name:BERRY, RITA (LPC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:BERRY
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 1:1973 J N PEASE PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4547
Mailing Address - Country:US
Mailing Address - Phone:704-394-8949
Mailing Address - Fax:704-393-3360
Practice Address - Street 1:1973 J N PEASE PL
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4547
Practice Address - Country:US
Practice Address - Phone:704-394-8949
Practice Address - Fax:704-393-3360
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102353Medicaid