Provider Demographics
NPI:1508576828
Name:BERRY, JENNIFER DELANA (LPC-S)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DELANA
Last Name:BERRY
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2602
Mailing Address - Country:US
Mailing Address - Phone:256-335-6160
Mailing Address - Fax:
Practice Address - Street 1:1810 JOHN R ST
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2981
Practice Address - Country:US
Practice Address - Phone:256-826-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional