Provider Demographics
NPI:1609813633
Name:BERRY, CHRISTINA M (LPCC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:M
Last Name:BERRY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40722 STATE ROUTE 154
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8500
Mailing Address - Country:US
Mailing Address - Phone:330-424-9573
Mailing Address - Fax:330-424-7140
Practice Address - Street 1:166 1/2 VINE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2939
Practice Address - Country:US
Practice Address - Phone:330-332-1514
Practice Address - Fax:330-332-4938
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0500699101Y00000X
OHE0500699101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor