Provider Demographics
NPI:1760631337
Name:BERRY, ANGELIA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELIA
Middle Name:MARIE
Last Name:BERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1009
Mailing Address - Country:US
Mailing Address - Phone:276-228-8775
Mailing Address - Fax:276-228-8776
Practice Address - Street 1:320 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1009
Practice Address - Country:US
Practice Address - Phone:276-228-8775
Practice Address - Fax:276-228-8776
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical