Provider Demographics
NPI:1033621610
Name:HEATHER BERRY COUNSELING, INC
Entity Type:Organization
Organization Name:HEATHER BERRY COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-417-2392
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:WOFFORD HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:93285-0363
Mailing Address - Country:US
Mailing Address - Phone:760-417-2392
Mailing Address - Fax:
Practice Address - Street 1:6501 WOFFORD BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:WOFFORD HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:93285-9800
Practice Address - Country:US
Practice Address - Phone:760-417-2392
Practice Address - Fax:760-417-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS182321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty