Provider Demographics
NPI:1154629913
Name:BERKELEY, NINA JOHANNA (LPC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:JOHANNA
Last Name:BERKELEY
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 1:1005 WHITE WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-6119
Mailing Address - Country:US
Mailing Address - Phone:304-460-5123
Mailing Address - Fax:800-734-8498
Practice Address - Street 1:120 PROFESSIONAL PL STE 101
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-4599
Practice Address - Country:US
Practice Address - Phone:304-460-5123
Practice Address - Fax:800-734-8498
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006093101YM0800X
WV2681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health