Provider Demographics
NPI:1245722669
Name:WALLACE-BERUBE, BERLINA (MACP, MED, LPC)
Entity type:Individual
Prefix:
First Name:BERLINA
Middle Name:
Last Name:WALLACE-BERUBE
Suffix:
Gender:F
Credentials:MACP, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7984
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-7984
Mailing Address - Country:US
Mailing Address - Phone:340-513-1353
Mailing Address - Fax:
Practice Address - Street 1:100B LA GRANDE PRINCESSE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-513-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-32843-1L101YM0800X
101YM0800X
VI1-32843-2B101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health