Provider Demographics
NPI:1346324381
Name:BERN COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:BERN COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:252-634-2855
Mailing Address - Street 1:1315 S GLENBURNIE RD
Mailing Address - Street 2:STE. D-17
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2613
Mailing Address - Country:US
Mailing Address - Phone:252-634-2855
Mailing Address - Fax:252-634-2955
Practice Address - Street 1:1315 S GLENBURNIE RD
Practice Address - Street 2:STE. D-17
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2613
Practice Address - Country:US
Practice Address - Phone:252-634-2855
Practice Address - Fax:252-634-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005874Medicaid
NC381759OtherTRICARE
NC128707OtherMEDCOST
NC018E0OtherBC