Provider Demographics
NPI:1497065015
Name:BARBER, DENTAVIUS LAMARN (LPC, LCASA)
Entity Type:Individual
Prefix:
First Name:DENTAVIUS
Middle Name:LAMARN
Last Name:BARBER
Suffix:
Gender:M
Credentials:LPC, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 MALLARD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7549
Mailing Address - Country:US
Mailing Address - Phone:803-487-8676
Mailing Address - Fax:
Practice Address - Street 1:5855 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 111
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8883
Practice Address - Country:US
Practice Address - Phone:704-537-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8231101YP2500X, 101YM0800X
NC2396-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6115040Medicaid