Provider Demographics
NPI:1891334322
Name:BERG, CAROLYN MAYER (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MAYER
Last Name:BERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GOLF VIEW LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-6912
Mailing Address - Country:US
Mailing Address - Phone:864-477-0379
Mailing Address - Fax:
Practice Address - Street 1:4328 WADE HAMPTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2244
Practice Address - Country:US
Practice Address - Phone:864-660-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-01
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0000OtherNO SUCH INFORMATION