Provider Demographics
NPI:1235851973
Name:BARRY, ANQUANITA (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ANQUANITA
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7776 FARMINGTON BLVD UNIT 38624
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-0108
Mailing Address - Country:US
Mailing Address - Phone:901-474-5709
Mailing Address - Fax:
Practice Address - Street 1:5270 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8581
Practice Address - Country:US
Practice Address - Phone:901-424-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health