Provider Demographics
NPI:1942368998
Name:BERLIN, AUDREY CONSTANCE (LPC)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:CONSTANCE
Last Name:BERLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 STATE ROUTE 725
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1552
Mailing Address - Country:US
Mailing Address - Phone:937-848-9858
Mailing Address - Fax:
Practice Address - Street 1:4301 STATE ROUTE 725
Practice Address - Street 2:SUITE B
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1552
Practice Address - Country:US
Practice Address - Phone:937-848-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-0004863101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health