Provider Demographics
NPI:1962873018
Name:BERLIN, KIRSTEN SIMONE (LPCA)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:SIMONE
Last Name:BERLIN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MARSH HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-5567
Mailing Address - Country:US
Mailing Address - Phone:910-478-8909
Mailing Address - Fax:
Practice Address - Street 1:4050 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2977
Practice Address - Country:US
Practice Address - Phone:252-240-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health