Provider Demographics
NPI:1699422527
Name:CRYSTAL H BERRY & CANDACE S BERRY
Entity type:Organization
Organization Name:CRYSTAL H BERRY & CANDACE S BERRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:803-580-0298
Mailing Address - Street 1:548 OLLIE RD
Mailing Address - Street 2:
Mailing Address - City:PELION
Mailing Address - State:SC
Mailing Address - Zip Code:29123-9400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:548 OLLIE RD
Practice Address - Street 2:
Practice Address - City:PELION
Practice Address - State:SC
Practice Address - Zip Code:29123-9400
Practice Address - Country:US
Practice Address - Phone:803-580-0298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty