Provider Demographics
NPI:1134703549
Name:BERKHART, AMBER MICHELLE (LCPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELLE
Last Name:BERKHART
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 LASALLE ROAD
Mailing Address - Street 2:CARROLL BUILDING, SUITE 212
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-773-0500
Mailing Address - Fax:
Practice Address - Street 1:8600 LASALLE ROAD
Practice Address - Street 2:CARROLL BUILDING, SUITE 212
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-773-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9809101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)